{ "hospital_name": "Lower Bucks Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Lower Bucks Hospital" ], "hospital_address": [ "501 Bath Road Bristol, PA 19007" ], "license_information": { "license_number": "460750728", "state": "PA" }, "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": "Michael J. Motte" }, "type_2_npi": [ "1528319621", "1992055305" ], "standard_charge_information": [ { "description": "Nicardipine Hcl Iv Soln 20 Mg/200Ml In Sodium Chloride 0.86% - 43066000910", "drug_information": { "unit": 200, "type": "ML" }, "code_information": [ { "code": "43066000910", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "Hc Clsd Treat Temporomandibl Disloc", "code_information": [ { "code": "21480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268, "discounted_cash": 242, "minimum": 28.98, "maximum": 268, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 268, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 268, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.98 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 268, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 268 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 268 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 268 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 268, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 268 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 268, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient New High Mdm 60-74 Minutes - G0463 - 76100005", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1249.13, "discounted_cash": 130, "minimum": 32.1715, "maximum": 999.304, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 144.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.62, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.69, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.81, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.59, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Work Hardening Ea Add Hr", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173, "minimum": 30.0847, "maximum": 173, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 173 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 168.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 167.25 } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180, "discounted_cash": 8, "minimum": 6.92, "maximum": 144, "payers_information": [ { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.3, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.21 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 42.21 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 36.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES - SOI : 1", "code_information": [ { "code": "3171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8306.16, "maximum": 8804.5296, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8306.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8804.53, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8306.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8306.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8721.47, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drainage Of Palmar Bursa Single Bursa", "code_information": [ { "code": "26025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6749.7, "discounted_cash": 3218, "minimum": 776, "maximum": 6749.7, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3540.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4506.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4828.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2575.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3862.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3315.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5175.25, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3637.37, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE - SOI : 3", "code_information": [ { "code": "6313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 50901.82, "maximum": 53955.9292, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 50901.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 53955.93, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 50901.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 50901.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 53446.91, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Fetal Biophysical Profile, W Nst", "code_information": [ { "code": "76818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2483, "discounted_cash": 102, "minimum": 58.09, "maximum": 1986.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 340.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 340.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 374.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.58 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Needle Biopsy Of Pancreas", "code_information": [ { "code": "48102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1839.5, "discounted_cash": 1624, "minimum": 319.889, "maximum": 1839.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1839.5, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1839.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1839.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1839.5, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1839.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1839.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1839.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1839.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1839.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1839.5, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1839.5, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1839.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Self Care Mngment Train Ea 15 Min", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211, "discounted_cash": 33, "minimum": 26.744, "maximum": 180, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 36.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 46.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 70.73, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 80.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 33.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 35.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 36.77, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 33.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.78, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274, "discounted_cash": 14, "minimum": 11.67, "maximum": 219.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.67 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.59 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.87, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 66.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W MAJOR ANOMALY - SOI : 1", "code_information": [ { "code": "6331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1897.87, "maximum": 2011.7422, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1897.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2011.74, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1897.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1897.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1992.76, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Nm Imaging, Whole Body, Single Day", "code_information": [ { "code": "78802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5707.73, "discounted_cash": 534, "minimum": 70, "maximum": 4566.184, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 587.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1291.22, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 747.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 801.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1189.57, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 427.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 730.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 730.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 802.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 640.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 550.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 560.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1141.12, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 858.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 603.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24732.45, "maximum": 26216.397, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24732.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 26216.4, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 24732.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24732.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25969.07, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Inject Nerv Blck,Paravert Sympath", "code_information": [ { "code": "64520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 488, "discounted_cash": 870, "minimum": 54, "maximum": 488, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 488 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 488 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 488 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 488 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 488, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatine", "code_information": [ { "code": "82540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65, "discounted_cash": 4, "minimum": 3.2, "maximum": 52, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.71 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.57 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rem Pac Cvdfb Plse Gen &Repl Plse Gen Sngl Lead", "code_information": [ { "code": "33262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57500, "discounted_cash": 21882, "minimum": 776, "maximum": 52896.6062, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22976.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 24070.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52896.61, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30635.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32824.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21882.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48732.71, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17506.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21882.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22757.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 21882.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26259.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22539.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 22976.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21882.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21882.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 46747.64, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35182.19, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21882.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21882.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24727.42, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chemother, Iv Infuse, Each Sequ Infus", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695.63, "discounted_cash": 70, "minimum": 56.664, "maximum": 556.504, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 77.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 171.22, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 157.74, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 56.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 59.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 65.72 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 70.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 74.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 151.31, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.88, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 70.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Iron Stain, Peripheral Blood", "code_information": [ { "code": "85536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.53, "discounted_cash": 6, "minimum": 5.5, "maximum": 91.624, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 32.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Diagnostic Computed Tomography Thorax W/O Cntrst", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2687, "discounted_cash": 102, "minimum": 82.272, "maximum": 2149.6, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 674.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 674.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 741.28 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 806.1, "10th_percentile": 806.1, "90th_percentile": 806.1, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.09 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.1 } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [ { "code": "369", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9400, "minimum": 5609.97, "maximum": 17005.23, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8951.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10340.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13100.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12220.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12362.47 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8525.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17005.23 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5679.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8525.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14729.46 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8525.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11280.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9682.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 9870.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9400.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8008.09 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8525.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 12853.57 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9903.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8525.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9400.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5609.97 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6284, "minimum": 3527.84, "maximum": 10717.95, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 6913.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8256.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8169.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 7791.74 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10717.95 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4618.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 5732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9387.96 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 5962.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 5732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 7541.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6473.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 6598.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6284.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7289.12 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 5732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 8101.27 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 6242.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5732.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6284.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3527.84 } ] } ] }, { "description": "Hc Reticulocyte Count, Auto", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31, "discounted_cash": 3, "minimum": 3.19, "maximum": 24.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.19 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 19.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Work Hardening Init 2 Hr", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "minimum": 120.8605, "maximum": 556, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 337.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 337.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 334.5 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS - SOI : 4", "code_information": [ { "code": "6814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 42205.82, "maximum": 44738.1692, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 42205.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 44738.17, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 42205.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 42205.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 44316.11, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mri Abdomen Wo Contrast", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3900, "discounted_cash": 234, "minimum": 187.776, "maximum": 3120, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 258.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 567.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 328.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1271.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 501.43, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ndsc Dcmprn 1 Ntrspc Lumbar", "code_information": [ { "code": "62380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34081.7, "discounted_cash": 7138, "minimum": 1582, "maximum": 27265.36, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7495.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7852.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17255.73, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9993.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10707.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15897.39, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5710.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 5505 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 5505 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 4362 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7424.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8566.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7352.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7495.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15249.83, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11477, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8066.48, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venogram Splenoportogram", "code_information": [ { "code": "75810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 3106, "minimum": 39, "maximum": 4788.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Excision Pilonidal Cyst/Sinus Complicated", "code_information": [ { "code": "11772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11624, "discounted_cash": 2857, "minimum": 776, "maximum": 9299.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3143.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6907.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4000.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4286.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6363.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2286.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2971.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3429.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2943.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6104.61, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4594.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3229.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "165", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17102, "minimum": 9450, "maximum": 32544.9, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 16198.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 18812.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25072.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22233.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 23659.51 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15427.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32544.9 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16845.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 15427.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 23447.48 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 16044.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 15427.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20523.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17615.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 17957.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19738.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 15427.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 24599.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 18954.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15427.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13186.45 } ] } ] }, { "description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [ { "code": "204", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7776, "minimum": 4121.05, "maximum": 13727.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7422.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8553.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10575.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10108.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9979.46 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7069.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13727.28 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4121.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7069.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10729.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7352.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7069.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9331.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8009.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8164.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7776.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6109.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7069.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10375.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7994.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7069.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7776.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12525.81 } ] } ] }, { "description": "Hc Xtrnl Ocular Photog W/I&R Docmt Medical Progre", "code_information": [ { "code": "92285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.5, "discounted_cash": 36, "minimum": 18.82, "maximum": 176.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.81, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.82 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.82, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 101.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 111.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.49, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Trg Gene Rearrangement Anal", "code_information": [ { "code": "81342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2084, "discounted_cash": 201, "minimum": 138.9, "maximum": 1667.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 161.2 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 221.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 282.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 426.31, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 467.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 467.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 400.18 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 241.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 207.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 211.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 241.8, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 241.8, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 227.7, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drug Assay Leflunomide", "code_information": [ { "code": "80193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.85, "discounted_cash": 38, "minimum": 26.6, "maximum": 154.28, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.58, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.86 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 42.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.57 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.6, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 60.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 51.62 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 46.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MASTECTOMY PROCEDURES - SOI : 3", "code_information": [ { "code": "3623", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18747.51, "maximum": 19872.3606, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18747.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 19872.36, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 18747.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18747.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19684.89, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE - SOI : 4", "code_information": [ { "code": "5804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9011.96, "maximum": 9552.6776, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9011.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9552.68, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9011.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9011.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9462.56, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Electrocardiogram, Tracing", "code_information": [ { "code": "93005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293, "discounted_cash": 58, "minimum": 10.46, "maximum": 234.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.46 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 195.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 193.12 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 87.9, "10th_percentile": 87.9, "90th_percentile": 6878.37, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Jaw 4+ Vw", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 544, "discounted_cash": 102, "minimum": 16.5, "maximum": 435.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 87.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 96.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fern Test - Q0114 - 30600080", "code_information": [ { "code": "Q0114", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228, "discounted_cash": 9, "minimum": 7.792, "maximum": 182.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.99 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 31.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Scan Extracranial,Limited", "code_information": [ { "code": "93882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1598, "discounted_cash": 102, "minimum": 82.272, "maximum": 1278.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1040.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1040.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1029.98 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cytopath C/V Index Add-On", "code_information": [ { "code": "88155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13, "discounted_cash": 14, "minimum": 3.9, "maximum": 13, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 4", "code_information": [ { "code": "2004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17467.21, "maximum": 18515.2426, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17467.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18515.24, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17467.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17467.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18340.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [ { "code": "516", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18483, "minimum": 14277.0665, "maximum": 35331.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 17498.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 20332.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27218.95 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24028.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 25685.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35331.5 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19931.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 16664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 23834.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 17331.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 16664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22180.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19038.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 19407.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18483.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26288 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 16664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 26705.66 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 20577.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18483.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [ { "code": "543", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9634, "minimum": 7062.617, "maximum": 17477.88, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9171.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10598.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13464.74 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12525.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12706.08 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17477.88 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8871.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14303.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9084.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11561.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9924.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 10116.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9634.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12594.4 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 13210.83 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10179.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8735.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9634.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 3", "code_information": [ { "code": "2013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7287.12, "maximum": 7724.3472, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7287.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7724.35, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7287.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7287.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7651.48, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cytopath, Cell Enhance Tech", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387, "discounted_cash": 51, "minimum": 41.008, "maximum": 309.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.24 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 56.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 123.91, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.26 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.16, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 101.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 86.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.74 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 51.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 53.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 109.51, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.41, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 51.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12662, "minimum": 6300, "maximum": 23586.64, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12020.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 13928.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18170.86 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16461.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 17147.03 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11448.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23586.64 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13629.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11448.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16900.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11906.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 11448.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15195.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13042.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 13295.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12662.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20600.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11448.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 17828.19 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13737.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11448.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12662.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 2", "code_information": [ { "code": "2032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5145.78, "maximum": 5454.5268, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5145.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5454.53, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5145.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5145.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5403.07, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Hemoglobin Electrophoresis", "code_information": [ { "code": "83020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242, "discounted_cash": 12, "minimum": 10.296, "maximum": 193.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 52.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 44.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Of Vagina", "code_information": [ { "code": "57200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10427.4, "discounted_cash": 3184, "minimum": 776, "maximum": 8341.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3343.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3503.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7698.08, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4458.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4776.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7092.1, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2547.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3311.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3821.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3343.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6803.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5120.09, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3598.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Cplx Trnk Add 5.0 Cm", "code_information": [ { "code": "13102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 851.38, "minimum": 148.055, "maximum": 851.38, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 851.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 851.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 851.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 851.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 851.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 851.38 } ] } ] }, { "description": "Hc Clsd Treat A-C Jt Disloc Wo Manip", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1519, "discounted_cash": 242, "minimum": 63, "maximum": 1519, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1519 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS - SOI : 4", "code_information": [ { "code": "3814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22316.86, "maximum": 23655.8716, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22316.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 23655.87, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 22316.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22316.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23432.7, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - G0480 - 30100071", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 610, "discounted_cash": 114, "minimum": 10.185, "maximum": 840, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 242.1, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "229", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27511, "minimum": 10800, "maximum": 56228.01, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 25993.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 30263.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41252.15 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35765.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 38927.82 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24755.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53547.26 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 33143.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 24755.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 56228.01 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 25745.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 24755.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33014.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28337.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 28887.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27511.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41412.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 24755.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 40474.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 31186.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24755.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 27511.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE W ECMO - SOI : 1", "code_information": [ { "code": "5831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 165628.04, "maximum": 175565.7224, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 165628.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 175565.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 165628.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 165628.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 173909.44, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2605, "discounted_cash": 3106, "minimum": 15, "maximum": 2605, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2605, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Emg, Needle, One Limb", "code_information": [ { "code": "95860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 484, "discounted_cash": 130, "minimum": 17.5, "maximum": 484, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.49, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 484 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 484 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 404.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM - SOI : 3", "code_information": [ { "code": "6403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2845.09, "maximum": 3015.7954, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2845.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3015.8, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2845.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2845.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2987.34, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "PULMONARY EMBOLISM - SOI : 2", "code_information": [ { "code": "1342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5848.17, "maximum": 6199.0602, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5848.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6199.06, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5848.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5848.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6140.58, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Heart Infarct Image", "code_information": [ { "code": "78466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 393, "minimum": 56, "maximum": 1865.248, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 432.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 950.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 550.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 875.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 314.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 323.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 355.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 409.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 471.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 840.16, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 632.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 444.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Single Transven Electrod/Pm/Defib", "code_information": [ { "code": "33218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6422, "discounted_cash": 3676, "minimum": 386.3, "maximum": 6422, "payers_information": [ { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6422, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2941.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 386.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3823.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4411.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3786.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3860.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6422, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5910.66, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4154.24, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3860.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4043.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6422, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5146.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5514.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Tomogram", "code_information": [ { "code": "76100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 527, "discounted_cash": 102, "minimum": 27.5, "maximum": 421.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 187.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 206.06 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES - SOI : 1", "code_information": [ { "code": "1671", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19668.06, "maximum": 20848.1436, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19668.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 20848.14, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19668.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19668.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20651.46, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Blood Draw <3 Yrs, Skilled Phys, Scalp", "code_information": [ { "code": "36405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136, "minimum": 23.6504, "maximum": 136, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 136 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 136 } ] } ] }, { "description": "Hc Mra Pelvis Wo Contrast - 72198 - 61800008", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2825, "minimum": 340, "maximum": 2260, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 340 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 360.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 340 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.2 } ] } ] }, { "description": "Hc Pure Tone Hearing Test Air", "code_information": [ { "code": "92551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211, "minimum": 8, "maximum": 168.8, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 } ] } ] }, { "description": "Hc Nitroblue Tetrazolium Dye", "code_information": [ { "code": "86384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160, "discounted_cash": 13, "minimum": 9.4, "maximum": 128, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.89 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.79, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 50.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 43.09 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.33 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Debridement Open Wound Ea Addl 20 Sq Cm", "code_information": [ { "code": "97598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512, "minimum": 89.0368, "maximum": 512, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 512 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 136.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 134.88 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 512 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 512 } ] } ] }, { "description": "Repair of metatarsals", "code_information": [ { "code": "28322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9243, "discounted_cash": 7138, "minimum": 776, "maximum": 9243, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7495.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7852.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9243, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9243, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9243, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9243, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5710.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7424.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8566.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7352.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7495.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9243, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9243, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8066.48, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES - SOI : 2", "code_information": [ { "code": "1672", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24926, "maximum": 26421.56, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24926, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 26421.56, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 24926, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24926, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26172.3, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Incision & Drain Pilonidal Cyst Simpl", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2828.1, "discounted_cash": 696, "minimum": 454.38, "maximum": 2828.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 766.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1683.98, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 975.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1551.42, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 557.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2828.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 724.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 835.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 717.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1488.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1120.03, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 787.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL MENINGITIS - SOI : 3", "code_information": [ { "code": "0513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10564.45, "maximum": 11198.317, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10564.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11198.32, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10564.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10564.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11092.67, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Fibrin Degradproducts,D-Dimer, Qual", "code_information": [ { "code": "85378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121, "discounted_cash": 9, "minimum": 7.776, "maximum": 96.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.86 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 28.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.66 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 4", "code_information": [ { "code": "9504", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40766.18, "maximum": 43212.1508, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 40766.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 43212.15, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 40766.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 40766.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 42804.49, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mri Guidance Needle Placement", "code_information": [ { "code": "77021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1979, "minimum": 201.06, "maximum": 1583.2, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 486.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 486.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 535.22 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 } ] } ] }, { "description": "Tis Trnfr S/A/L 10 Sq Cm/<", "code_information": [ { "code": "14020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10293, "discounted_cash": 2029, "minimum": 776, "maximum": 8234.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2131.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2232.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4906.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2841.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3044.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4520.36, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1623.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2110.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2435.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2090.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2131.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4336.23, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2293.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Pelvis Wo/W Contrast - C8920 - 61800009", "code_information": [ { "code": "C8920", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2825, "discounted_cash": 343, "minimum": 217.42, "maximum": 2260, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 405 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 405 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [ { "code": "279", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31362, "minimum": 7386, "maximum": 61315.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 29615.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 34498.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47236.63 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 40770.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 44575.1 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28205.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61315.4 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 20409.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 28205.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 29333.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 28205.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37634.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 32302.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 32930.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31362.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32965 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 28205.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 46345.85 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 35710.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28205.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31362.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7386 } ] } ] }, { "description": "Hc Ct Scan,Abdomen,W/O Contrast", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2375.61, "discounted_cash": 102, "minimum": 77.5, "maximum": 1900.488, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 654.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 654.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 719.87 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 712.68, "10th_percentile": 712.68, "90th_percentile": 712.68, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Continuous Inhalation Tx, Each Add Hr", "code_information": [ { "code": "94645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.75, "minimum": 9.8, "maximum": 282.2, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7065, "minimum": 3926.43, "maximum": 12294.02, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6754.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7772.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9471.16 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9185.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8937.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6432.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12294.02 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6816.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6432.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10511.13 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7650, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6690.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6432.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8478.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7277.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7418.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7065.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9841.33 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6432.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9292.56 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7160.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6432.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7065.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3926.43 } ] } ] }, { "description": "LOWER EXTREMITY ARTERIAL PROCEDURES - SOI : 1", "code_information": [ { "code": "1811", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13382.87, "maximum": 14185.8422, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13382.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 14185.84, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 13382.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13382.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14052.01, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Exc Hip Pelvis Les Sc 3 Cm/>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6993, "discounted_cash": 2857, "minimum": 776, "maximum": 6907.5796, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3143.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6907.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4000.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4286.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6363.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2286.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2971.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3429.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2943.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6104.61, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4594.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3229.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Physostigmine Salicylate Inj 1 Mg/Ml - 17478051002", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "17478051002", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "Hc Fibrin Degrad Products, Agglutination", "code_information": [ { "code": "85362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133, "discounted_cash": 6, "minimum": 5.51, "maximum": 106.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.51 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 28.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strapping Knee", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 130, "minimum": 25.5, "maximum": 513.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.49, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 354.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 354.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 350.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colonoscopy,Flex,W/Control, Bleeding", "code_information": [ { "code": "45382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904.8, "discounted_cash": 1177, "minimum": 269.2, "maximum": 2904.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1294.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2845.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1648.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1765.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.67, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 941.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1412.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1212.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2514.88, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1892.69, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1330.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myelography Lumbar Inj, 2+ Regions", "code_information": [ { "code": "62305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5096, "discounted_cash": 771, "minimum": 616.952, "maximum": 4076.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 848.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.18, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1079.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1156.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1717.44, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 616.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 802.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 925.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 794.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 809.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1647.48, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1239.89, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 871.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4450) Non-Waterproof Tape - A4450 - 27090028", "code_information": [ { "code": "A4450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 137.72, "10th_percentile": 137.72, "90th_percentile": 137.72, "count": "1 through 10" } ] } ] }, { "description": "Hc Fine Needle Aspiration Bx W/Mr Gdn 1St Lesion", "code_information": [ { "code": "10011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2896.7, "discounted_cash": 696, "minimum": 503.7361, "maximum": 2896.7, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 766.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1683.98, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 975.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1551.42, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 557.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2896.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 724.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 835.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 717.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1488.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1120.03, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 787.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548, "discounted_cash": 3106, "minimum": 95.2972, "maximum": 548, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 333.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 333.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 366.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 548 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 548, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES- SOI : 3", "code_information": [ { "code": "1833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37825.34, "maximum": 40094.8604, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 37825.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 40094.86, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 37825.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 37825.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 39716.61, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drainage Of Pelvic Abscess", "code_information": [ { "code": "57010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10427.4, "discounted_cash": 3184, "minimum": 776, "maximum": 8341.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3343.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3503.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7698.08, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4458.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4776.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7092.1, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2547.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3311.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3821.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3343.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6803.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5120.09, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3598.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIESINTRALUMINAL DEVICES", "code_information": [ { "code": "321", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23899, "minimum": 6726.45, "maximum": 46258.58, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 22594.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 26289.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35637.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31069.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 33629.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21518.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46258.58 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 26574.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 21518.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 22378.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 21518.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28679.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 24616.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 25094.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23899.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34551.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 21518.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 34965 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 26941.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21518.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23899.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6726.45 } ] } ] }, { "description": "Hc Hypnotherapy", "code_information": [ { "code": "90880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.05, "discounted_cash": 99, "minimum": 63.31, "maximum": 504.04, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 109.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 241.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 139.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 149.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 222.57, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 79.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 99.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 119.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 104.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 99.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 213.5, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.68, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 99.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 112.93, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Stool Culture,Salmonella & Shigella", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240, "discounted_cash": 9, "minimum": 6.9, "maximum": 192, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.55 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.97, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 39.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15913, "minimum": 6980.8, "maximum": 30145.94, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15079.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17504.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23224.06 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20687.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21915.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14361.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30145.94 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9524.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14361.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 22115.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14936.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 14361.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19096.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16391.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 16709.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17038.6 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14361.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 22786.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17557.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14361.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15913.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6980.8 } ] } ] }, { "description": "Hc X-Ray Thoracic Spine+Swim 3 Vw", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534, "discounted_cash": 102, "minimum": 21.5, "maximum": 427.2, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 92.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 160.2, "10th_percentile": 160.2, "90th_percentile": 370.5, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" } ] } ] }, { "description": "ORGANIC MENTAL HEALTH DISTURBANCES - SOI : 1", "code_information": [ { "code": "7571", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4192.41, "maximum": 4443.9546, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4192.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4443.95, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4192.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4192.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4402.03, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8124.92, "maximum": 8612.4152, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8124.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8612.42, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8124.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8124.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8531.17, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Treat Metacarpal Fracture - 26608 - OR36026608", "code_information": [ { "code": "26608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6918, "discounted_cash": 3218, "minimum": 776, "maximum": 6918, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3540.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6918, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4506.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4828.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6918, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2575.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3862.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3315.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6876.51, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5175.25, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3637.37, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rtrvl Intrvas Vc Filtr W/Wo Acs Vsl Selxn Rs&I", "code_information": [ { "code": "37193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7948, "discounted_cash": 3106, "minimum": 1382.1572, "maximum": 7508.6611, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7508.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6917.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OPEN CRANIOTOMY FOR TRAUMA- SOI : 2", "code_information": [ { "code": "0202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19836.98, "maximum": 21027.1988, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19836.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21027.2, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19836.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19836.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20828.83, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drain/Inject Intermediate Joint/Bursa", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1190.52, "discounted_cash": 301, "minimum": 207.0314, "maximum": 1190.52, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 332.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 729.92, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 422.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 452.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1190.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 672.46, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 241.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1190.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 362.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 311.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 317.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1094 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 645.07, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 485.48, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1190.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 341.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 4", "code_information": [ { "code": "0894", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 41032.91, "maximum": 43494.8846, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 41032.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 43494.88, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 41032.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 41032.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 43084.56, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Epstein-Barr Antibody,Nuclear", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324, "discounted_cash": 15, "minimum": 12.23, "maximum": 259.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.23 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 67.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.07 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.05, "discounted_cash": 12, "minimum": 3.615, "maximum": 12.05, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17343, "minimum": 5400, "maximum": 33031.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 16425.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 19077.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25446.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22546.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 24013.01 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33031.16 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 17115.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21965.56 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 16268.93, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 15643.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20812.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17863.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 18210.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17343.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24044.6 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 15643.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 24966.92 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 19237.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15643.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17343.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6594.33 } ] } ] }, { "description": "Hc Angio Aortogram Thoracic", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4361, "discounted_cash": 3106, "minimum": 16.5, "maximum": 4361, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4361, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4361, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4361, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE DT MUSCSKEL MALIG - SOI : 3", "code_information": [ { "code": "3433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12597.05, "maximum": 13352.873, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12597.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13352.87, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12597.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12597.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13226.9, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC", "code_information": [ { "code": "939", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31548, "minimum": 24928.7021, "maximum": 61691.14, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 29791.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 34703.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47526.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 41012.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 44848.26 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61691.14 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 27719.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 28372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 40169.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 29507.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 28372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37857.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 32494.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 33125.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31548.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33373.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 28372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 46629.85 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 35929.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31548.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE - SOI : 2", "code_information": [ { "code": "1942", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5662.82, "maximum": 6002.5892, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5662.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6002.59, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5662.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5662.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5945.96, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Legion Pneumo Ag, Dfa", "code_information": [ { "code": "87278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95, "discounted_cash": 15, "minimum": 10.8, "maximum": 76, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.48 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 3", "code_information": [ { "code": "0423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10786.04, "maximum": 11433.2024, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10786.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11433.2, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10786.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10786.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11325.34, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "RESPIRATORY MALIGNANCY - SOI : 2", "code_information": [ { "code": "1362", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7432.12, "maximum": 7878.0472, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7432.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7878.05, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7432.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7432.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7803.73, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Imm Admn Sarscov2 Ad26 5X1010 Vp/0.5 Ml 1 Dose", "code_information": [ { "code": "0031A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "minimum": 4, "maximum": 40, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40 } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 3", "code_information": [ { "code": "3163", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15168.57, "maximum": 16078.6842, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15168.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16078.68, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15168.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15168.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15927, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CCMCC", "code_information": [ { "code": "976", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8579, "minimum": 6201.7747, "maximum": 15347.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8178.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9437.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11823.56 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11152.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11157.37 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7789.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15347.55 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7287.56 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7789.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 12734.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8100.58, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7789.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10294.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8836.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 9008.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8579.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11893.6 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7789.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 11600.6 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8938.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7789.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8579.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Radiologic Exam Abdomen 3+ Views", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.57, "discounted_cash": 102, "minimum": 19.17, "maximum": 630.056, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 99.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 90.05 } ] } ] }, { "description": "Hc Change Of Bladder Tube,Simple", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1003.1, "discounted_cash": 245, "minimum": 174.4391, "maximum": 1003.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 270.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 594.14, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 344.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 368.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1003.1 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 547.37, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1003.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 258.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 525.08, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 395.17, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1003.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 277.74, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 1500-1999G W CONGENITALPERINATAL INFECTION - SOI : 4", "code_information": [ { "code": "6134", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 71500.68, "maximum": 75790.7208, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 71500.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 75790.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 71500.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 71500.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 75075.71, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE - SOI : 2", "code_information": [ { "code": "2522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6467.79, "maximum": 6855.8574, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6467.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6855.86, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6467.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6467.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6791.18, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION - SOI : 1", "code_information": [ { "code": "6391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2809.53, "maximum": 2978.1018, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2809.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2978.1, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2809.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2809.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2950.01, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Psychotherapy Patient &/ Family 45 Minutes", "code_information": [ { "code": "90834", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480, "discounted_cash": 174, "minimum": 83.472, "maximum": 422.0818, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 183.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 192.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 422.08, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 244.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 388.86, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 183.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 373.02, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.73, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 197.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glutathione", "code_information": [ { "code": "82978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194, "discounted_cash": 15, "minimum": 6.75, "maximum": 155.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.36 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 20.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 1000-1249G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 4", "code_information": [ { "code": "6034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 82097.28, "maximum": 87023.1168, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 82097.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 87023.12, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 82097.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 82097.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 86202.14, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Contrast Inj Perq Radiologic Eval Gi Tube", "code_information": [ { "code": "49465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1152.8, "discounted_cash": 234, "minimum": 23.74, "maximum": 1152.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 258.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 567.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 328.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.74 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 729.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 729.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 729.84 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 501.43, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1152.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEO BWT<500G OR 500-999G & GA<24WKS OR 500-749G W MAJ ANOM OR WOUT LIFE SUSTAINING INTERVENTION- SOI : 3", "code_information": [ { "code": "5893", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 120467.7, "maximum": 127695.762, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 120467.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 127695.76, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 120467.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 120467.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 126491.09, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8452, "minimum": 5794.01, "maximum": 15092.52, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8452.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9297.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11627.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10988.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10971.97 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7675.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15092.52 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5794.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7675.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11862.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7982.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7675.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10143.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8706.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8875.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8452.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6747.49 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7675.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 11407.83 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8790.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7675.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Chest W Contrast, Exclude Heart - C8909 - 61800004", "code_information": [ { "code": "C8909", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3154, "discounted_cash": 343, "minimum": 217.42, "maximum": 2523.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 405 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 405 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Breath Recording, Infant", "code_information": [ { "code": "94772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2329, "discounted_cash": 367, "minimum": 132, "maximum": 1863.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 403.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 887.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 513.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 550.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 817.53, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 293.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.98 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 157.98 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 156.46 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 139.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 381.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 378.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 385.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 784.23, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 590.21, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 776, "discounted_cash": 20, "minimum": 16.648, "maximum": 620.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.65 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 101.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 86.71 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Diag W Bronch Bx", "code_information": [ { "code": "31625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5275.6, "discounted_cash": 1751, "minimum": 664, "maximum": 4232.7109, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1838.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1926.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4232.71, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2451.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2626.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3899.52, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1821.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2101.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1803.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1838.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 664 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3740.68, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2815.23, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1978.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Lymphocytotoxicity Assay - 86805 - 30200179", "code_information": [ { "code": "86805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 374.28, "discounted_cash": 189, "minimum": 44.07, "maximum": 374.28, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 151.61 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 208.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 189.51 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 265.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 284.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.07 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 374.28, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 151.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 137.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 118.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 189.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 195.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 198.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 189.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 227.41 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 189.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.15, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Intrinsic Factor Antibody", "code_information": [ { "code": "86340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 222, "discounted_cash": 15, "minimum": 12.06, "maximum": 177.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.06 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.83 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.9, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Edg Flex Endoscopic Mucosal Resection", "code_information": [ { "code": "43254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 1887, "minimum": 621.7412, "maximum": 3575.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2076.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2642.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1510.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1963.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2265.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1944.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3035.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2133.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ed Level 3", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1146.85, "discounted_cash": 268, "minimum": 56.65, "maximum": 917.48, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 281.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 295.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 649.16, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 375.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 402.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 334 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 598.06, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 214.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 886 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 886 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 666 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 344.06, "10th_percentile": 344.05, "90th_percentile": 344.06, "count": "35" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 387 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 268.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 380 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 276.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 281.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 268.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 573.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 431.77, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 268.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 303.46, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE - SOI : 1", "code_information": [ { "code": "7101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10302.51, "maximum": 10920.6606, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10302.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10920.66, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10302.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10302.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10817.64, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Med Malleolus Fx W Manip", "code_information": [ { "code": "27762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1581, "minimum": 165.5, "maximum": 4869.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1740.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3823.9, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2214.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3522.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1265.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1645.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1629.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3379.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1787.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Cath Subsubselect Art,Abd/Pel", "code_information": [ { "code": "36247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2622, "minimum": 455.9658, "maximum": 2622, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2622 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2622 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2622 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2622 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2622 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 4", "code_information": [ { "code": "1924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24547.8, "maximum": 26020.668, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24547.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 26020.67, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 24547.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24547.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25775.19, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Canalith Repositioning Per Day", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211, "discounted_cash": 30, "minimum": 24.392, "maximum": 180, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 42.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.51, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 109.4, "10th_percentile": 109.4, "90th_percentile": 109.4, "count": "1 through 10" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 205.85, "10th_percentile": 205.85, "90th_percentile": 205.85, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 32.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 36.59, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.59, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serum Sodium", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87, "discounted_cash": 4, "minimum": 3.848, "maximum": 69.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.85 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Lower Extrem W Contrast - C8912 - 61600001", "code_information": [ { "code": "C8912", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4385, "discounted_cash": 343, "minimum": 217.42, "maximum": 3508, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 405 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 405 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24428.11, "maximum": 25893.7966, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24428.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 25893.8, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 24428.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24428.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25649.52, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cath Plc/Cor Angio Rs/I Bypas Angio W R Ht Cath", "code_information": [ { "code": "93457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17371.5, "discounted_cash": 3189, "minimum": 1582, "maximum": 13897.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3348.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3508.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7709.51, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4784, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7102.64, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2551.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3316.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3827.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3285.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3348.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6813.32, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5127.69, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3603.94, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drain Ext Ear Absc/Blood,Simple", "code_information": [ { "code": "69000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297, "discounted_cash": 696, "minimum": 51.6483, "maximum": 297, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 297 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 297 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 297 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 297 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 297 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 297 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 297 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flx Transoral Lesion Ablation", "code_information": [ { "code": "43229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9575.75, "discounted_cash": 3792, "minimum": 776, "maximum": 9168.5369, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3982.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4172.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9168.54, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5310.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5689.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3792.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8446.81, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3034.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3792.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3944.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3792.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4551.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3906.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3982.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3792.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3792.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8102.74, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6098.11, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3792.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3792.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4285.99, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us, Eye Biometry W Lens Calc", "code_information": [ { "code": "76519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.02, "discounted_cash": 102, "minimum": 40.76, "maximum": 335.216, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 182.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 200.71 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH,THROAT & CRANIALFACIAL DIAGNOSES - SOI : 4", "code_information": [ { "code": "1154", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16866.74, "maximum": 17878.7444, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16866.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 17878.74, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 16866.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16866.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17710.08, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8060, "discounted_cash": 3106, "minimum": 22.5, "maximum": 7508.6611, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7508.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6917.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% 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": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Partial Removal Of Foot Bone - 28122 - OR36028122", "code_information": [ { "code": "28122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8223, "discounted_cash": 3218, "minimum": 776, "maximum": 7781.0164, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2575.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3862.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3315.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6876.51, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5175.25, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3637.37, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3540.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7781.02, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4506.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4828.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7168.51, "additional_payer_notes": "222.70% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "724", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6497, "minimum": 4504.8229, "maximum": 11148.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7147.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8588.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8447.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8104.45 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5923.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11148.1 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6978.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 5923.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9810.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6160.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 5923.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 7797.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6692.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 6822.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6497.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8639.47 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 5923.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 8426.4 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 6492.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5923.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6497.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR LARGE BOWEL PROCEDURES - SOI : 3", "code_information": [ { "code": "2313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20940.82, "maximum": 22197.2692, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20940.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 22197.27, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 20940.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20940.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21987.86, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Rhythm Ecg, Tracing", "code_information": [ { "code": "93041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171, "discounted_cash": 58, "minimum": 5.06, "maximum": 140.2749, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 97.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 96.56 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOCRINE DISORDERS - SOI : 3", "code_information": [ { "code": "4243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9970.13, "maximum": 10568.3378, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9970.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10568.34, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9970.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9970.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10468.64, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR O.R. PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS - SOI : 1", "code_information": [ { "code": "6801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12589.53, "maximum": 13344.9018, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12589.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13344.9, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12589.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12589.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13219.01, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bone Biopsy,Excisional Superf", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 2857, "minimum": 842, "maximum": 8595.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3143.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6907.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4000.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4286.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6363.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2286.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2971.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3429.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2943.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 842 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6104.61, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4594.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3229.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 3", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6776.92, "maximum": 7183.5352, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6776.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7183.54, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6776.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6776.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7115.77, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 1", "code_information": [ { "code": "3141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7517.6, "maximum": 7968.656, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7517.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7968.66, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7517.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7517.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7893.48, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ketone Bodies Serum Quantitative", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234, "discounted_cash": 8, "minimum": 5, "maximum": 187.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 29.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 25.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE - SOI : 1", "code_information": [ { "code": "0441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6649.03, "maximum": 7047.9718, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6649.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7047.97, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6649.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6649.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6981.48, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15986, "minimum": 4761.04, "maximum": 30292.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15148.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17584.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23336.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20781.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 22021.81 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30292.16 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16133.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 22950.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15003.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 14426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19183.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16465.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 16785.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15986.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24867.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 22896.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17642.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14426.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15986.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4761.04 } ] } ] }, { "description": "Hc Thrombin Time, Plasma", "code_information": [ { "code": "85670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47, "discounted_cash": 5, "minimum": 4.616, "maximum": 37.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.62 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 27.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 23.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient New Moderate Mdm 45-59 Minutes - G0463 - 76100004", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1249.13, "discounted_cash": 130, "minimum": 32.1715, "maximum": 999.304, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 144.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.62, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.69, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.81, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.59, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Percut Drain/Inject Renal Cyst", "code_information": [ { "code": "50390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1817.34, "discounted_cash": 696, "minimum": 316.0354, "maximum": 1817.34, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 766.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1683.98, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 975.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1551.42, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 557.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1817.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1817.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1817.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1817.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 724.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 835.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 717.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1488.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1120.03, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1817.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 787.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "832", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7053, "minimum": 3380.87, "maximum": 12268.52, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6742.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7758.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9451.52 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9168.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8918.98 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6421.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12268.52 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3380.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6421.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10157.06 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6678.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6421.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8463.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7264.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7405.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4761.48 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6421.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9273.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7145.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6421.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7053.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - G0480 - 30100422", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469.16, "discounted_cash": 114, "minimum": 10.185, "maximum": 840, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 242.1, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Angio, Chest, Combo, Incl Image Proc", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3235, "discounted_cash": 172, "minimum": 138.04, "maximum": 2588, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 189.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 417.1, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 241.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 384.27, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 963.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1059.74 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 181.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.42, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 194.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lrh Hormone", "code_information": [ { "code": "83727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.78, "discounted_cash": 17, "minimum": 13.75, "maximum": 168.624, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.37, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 83.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 71.72 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.75 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Lip,<1/2 Vert Height", "code_information": [ { "code": "40652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2213.1, "discounted_cash": 530, "minimum": 384.8581, "maximum": 2213.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 557.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 583.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1282.56, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 742.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 795.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1181.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 424.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 636.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 546.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 557.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1133.47, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 853.05, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 599.56, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SHOULDER & ELBOW JOINT REPLACEMENT - SOI : 4", "code_information": [ { "code": "3224", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25749.44, "maximum": 27294.4064, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 25749.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 27294.41, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 25749.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25749.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27036.91, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS - SOI : 1", "code_information": [ { "code": "4211", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3955.09, "maximum": 4192.3954, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3955.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4192.4, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3955.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3955.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.84, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER OPEN CRANIOTOMY- SOI : 3", "code_information": [ { "code": "0273", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27775.88, "maximum": 29442.4328, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 27775.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 29442.43, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 27775.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27775.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29164.67, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE - SOI : 2", "code_information": [ { "code": "8502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17734.63, "maximum": 18798.7078, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17734.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18798.71, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17734.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17734.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18621.36, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24272.86, "maximum": 25729.2316, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24272.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 25729.23, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 24272.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24272.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25486.5, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 3", "code_information": [ { "code": "0923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22226.59, "maximum": 23560.1854, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22226.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 23560.19, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 22226.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22226.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23337.92, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Motor &/Sens 1-2 Nrv Cndj Preconf Eltrode Limb", "code_information": [ { "code": "95907", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 635.5, "discounted_cash": 212, "minimum": 31.48, "maximum": 513.4551, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 233.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 513.46, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 297.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 473.04, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 227.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 173.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 218.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 223.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 453.77, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.51, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 240.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Post Hip Arthrplas Disloc W Anes", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326, "discounted_cash": 242, "minimum": 56.6914, "maximum": 326, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 326, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 326, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 326, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 326, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 326 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 326 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 326 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 251.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 326, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 326, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 326 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Revasc Lithotr-Ather Tib/Per", "code_information": [ { "code": "C9774", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83536.6, "discounted_cash": 18034, "minimum": 1582, "maximum": 66829.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18935.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19837.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43593.77, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25247.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27051.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40162.16, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14427.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18755.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21641.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18575.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18935.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38526.21, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28994.76, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20378.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Stem Cells Total Count", "code_information": [ { "code": "86367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.04, "discounted_cash": 77, "minimum": 42.16, "maximum": 246.432, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 62.22 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 108.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 116.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.16 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 164.56, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 115.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 99.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 77.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 81.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 77.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 93.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 77.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.89, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Eval Fna Smear To Determin Adequacy, First Eval", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.06, "discounted_cash": 167, "minimum": 44.85, "maximum": 221.06, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 44.85 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 184.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 221.06, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 221.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 221.06, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 134.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 53.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 221.06, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.06, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 189.39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Revasc Chro Sin - C9607 - 48100199", "code_information": [ { "code": "C9607", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20599, "discounted_cash": 18034, "minimum": 1582, "maximum": 68710.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18935.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19837.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20599, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20599, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20599, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20599, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14427.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18755.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20599, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18575.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18935.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20599, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20599, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20378.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8524, "minimum": 4764.14, "maximum": 15237.04, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8126.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9376.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11738.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11081.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11077.03 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7739.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15237.04 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4764.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7739.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11955.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8049.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7739.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10229.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8780.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8950.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8524.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6765.64 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7739.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 11517.07 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8874.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7739.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8524.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Brain", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3241.69, "discounted_cash": 234, "minimum": 187.776, "maximum": 2593.352, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 258.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 567.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 328.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1271.15 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 972.51, "10th_percentile": 972.51, "90th_percentile": 1975.32, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 501.43, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "033", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14985, "minimum": 2817.65, "maximum": 28272.34, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14205.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16483.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21780.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19480.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20553.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13529.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28272.34 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11510.35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13529.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21516.53 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14070.68, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 13529.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17982.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15434.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 15734.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14985.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19040.6 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13529.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 21369.93 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16466.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13529.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14985.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2817.65 } ] } ] }, { "description": "Hc Place Interstitial Dev, Intra-Thoracic, Perq", "code_information": [ { "code": "32553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5331.2, "discounted_cash": 1361, "minimum": 289.7375, "maximum": 4264.96, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1429.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1497.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3291.52, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1906.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2042.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3032.42, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1089.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 289.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 289.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 304.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1416.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1633.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1402.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1429.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2908.9, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2189.23, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1538.68, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7926, "minimum": 4584.15, "maximum": 27665.56, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7563.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8718.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10808.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10303.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10199.47 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7203.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14029.91 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4646.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7203.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11399.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7203.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9511.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8163.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8322.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7926.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4584.15 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7203.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10604.65 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8171.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7203.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7926.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27665.56 } ] } ] }, { "description": "Hc Intravasc Us,Heart,1St Vessel", "code_information": [ { "code": "92978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2067, "minimum": 150.13, "maximum": 2067, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2067 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2067 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8970, "minimum": 6520.5543, "maximum": 22897.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8546.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9867.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12431.31 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11661.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11730.88 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8139.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16136.44 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8243.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8139.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13473.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8464.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8139.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10764.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9239.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 9418.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8970.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9959.91 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8139.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 12196.88 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9397.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8139.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8970.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22897.91 } ] } ] }, { "description": "Hc Clsd Treat Fingr Articular Fx W Manip Ea", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6460.37, "discounted_cash": 1581, "minimum": 73.5, "maximum": 5168.296, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1740.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3823.9, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2214.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3522.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1265.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1645.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1629.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3379.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1787.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bone Marrow Bx, Needle/Trocar", "code_information": [ { "code": "38221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1224, "discounted_cash": 1624, "minimum": 212.8536, "maximum": 1224, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1224 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1224 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1224 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1224, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30993, "minimum": 7381.59, "maximum": 60570.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 29268.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 34092.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46662.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 40290.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 44033.74 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60570.72 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 30391.36 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 27874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 43669.18 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 28989.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 27874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37191.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 31922.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 32542.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30993, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41548.9 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 27874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 45782.97 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 35276.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 30993, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7381.59 } ] } ] }, { "description": "Hc Ph Body Fluid Nos", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113, "discounted_cash": 3, "minimum": 2, "maximum": 90.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 2.86 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.58 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.3 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Multiple Vitamin Inj", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "54643564901", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS - SOI : 1", "code_information": [ { "code": "3821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5525.36, "maximum": 5856.8816, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5525.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5856.88, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5525.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5525.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5801.63, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Epi Autogrft Face/Nck/Hnd/Ft/Gen , Ea 100 Sqcm", "code_information": [ { "code": "15116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1501.19, "minimum": 261.0569, "maximum": 1501.19, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1501.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1501.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1501.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1501.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1501.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1501.19 } ] } ] }, { "description": "Hc Ct Heart W/O Contrast Quant Eval Coronary Calcium", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 637, "discounted_cash": 85, "minimum": 34.78, "maximum": 637, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 94.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 206.94, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 119.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.78 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 190.65, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 68.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 637 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 637 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 637 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.03, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 89.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 182.89, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.64, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.74, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST & RESPIRATORY TRAUMA - SOI : 4", "code_information": [ { "code": "1354", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17177.23, "maximum": 18207.8638, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17177.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18207.86, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17177.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17177.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18036.09, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Egd Transoral Control Bleeding Any Method", "code_information": [ { "code": "43255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1225, "discounted_cash": 1887, "minimum": 213.0275, "maximum": 1225, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1225 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1225 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1225 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1225 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 246.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1225 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 356 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1225 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1225, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mucopolysaccharides", "code_information": [ { "code": "83864", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280, "discounted_cash": 28, "minimum": 18, "maximum": 224, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.8 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 99.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 84.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MALFUNCTION,REACTION,COMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE - SOI : 2", "code_information": [ { "code": "2062", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6815.22, "maximum": 7224.1332, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6815.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7224.13, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6815.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6815.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7155.98, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ileoscopy Thru Stoma Biopsy Sing/Mult", "code_information": [ { "code": "44382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890, "discounted_cash": 892, "minimum": 73.9, "maximum": 2890, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 936.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 981.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2156.87, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1249.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1338.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 892.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1987.09, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 713.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 892.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 892.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1070.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 919.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 936.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 892.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 892.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1906.14, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1434.56, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 892.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 892.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1008.27, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Corticosteroids", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 483, "discounted_cash": 17, "minimum": 7, "maximum": 386.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.87, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 87.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 75.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Audiometry Air & Bone", "code_information": [ { "code": "92553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 126, "minimum": 14, "maximum": 519, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 305.98, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 177.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 189.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 281.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 101.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 99.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 151.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 132.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 270.41, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 203.51, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Teletherapy Isodode Plan, Simple", "code_information": [ { "code": "77306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 702, "discounted_cash": 368, "minimum": 54.49, "maximum": 702, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 386.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 405.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 702, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 515.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 552.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.49 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 702, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 294.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 141.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 148.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 368.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 442.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 379.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 386.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 702, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 592.22, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 368.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Rad/Ulna Shaft Fx Wo Manip", "code_information": [ { "code": "25560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 242, "minimum": 114.5, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Stent Des Each Add Branch", "code_information": [ { "code": "C9601", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25933.8, "minimum": 1582, "maximum": 20747.04, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "Hc Clsd Treat Ulna Shaft Fx W Manip", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 242, "minimum": 160.5, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Complete Cbc", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240, "discounted_cash": 6, "minimum": 5.176, "maximum": 192, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 31.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 26.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Heart Contrast Eval Cardiac Struct/Morph", "code_information": [ { "code": "75572", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2544, "discounted_cash": 343, "minimum": 169.03, "maximum": 2035.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.03 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 973.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 973.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1070.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 130, "minimum": 89.2872, "maximum": 513.44, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.91, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.49, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 513.44 } ] } ] }, { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES - SOI : 3", "code_information": [ { "code": "3123", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25868.44, "maximum": 27420.5464, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 25868.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 27420.55, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 25868.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25868.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27161.86, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14424, "minimum": 5696.95, "maximum": 27141.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13678.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15867.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20909.65 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18752.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 19731.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13027.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27141.72 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19731.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13027.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13548.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 13027.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17309.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14857.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 15145.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19053.4 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13027.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 20515.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15807.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13027.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14424.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5696.95 } ] } ] }, { "description": "Hc Arc Blood Typing, Rbc Antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327.18, "discounted_cash": 352, "minimum": 3.06, "maximum": 327.18, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.06 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 327.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Igh Rearrange Abnormal Clonal Pop Amplified", "code_information": [ { "code": "81261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 888, "discounted_cash": 197, "minimum": 158.39, "maximum": 710.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 158.39 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 217.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 277.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.54 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 418.89, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 459.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 459.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 393.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 203.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 207.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 237.59, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.59, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 223.73, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 500-749G WO MAJOR PROCEDURE - SOI : 4", "code_information": [ { "code": "5914", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 169470.97, "maximum": 179639.2282, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 169470.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 179639.23, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 169470.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 169470.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 177944.52, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS - SOI : 4", "code_information": [ { "code": "8614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12726.99, "maximum": 13490.6094, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12726.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13490.61, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12726.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12726.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13363.34, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc I&D Forearm Deep Abscess", "code_information": [ { "code": "25028", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3581.2, "discounted_cash": 3218, "minimum": 622.7707, "maximum": 3581.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3540.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2575.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3581.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3315.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES- SOI : 2", "code_information": [ { "code": "1442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6227.74, "maximum": 6601.4044, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6227.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6601.4, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6227.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6227.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6539.13, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Respiratory Virus", "code_information": [ { "code": "86756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 555, "discounted_cash": 15, "minimum": 12.71, "maximum": 444, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.71 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.79 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.62, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER GASTROENTERITIS, NAUSEA & VOMITING - SOI : 3", "code_information": [ { "code": "2493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7347.99, "maximum": 7788.8694, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7347.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7788.87, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7347.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7347.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7715.39, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Diagnostic Bone Marrow Biopsies & Aspirations", "code_information": [ { "code": "38222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6740.15, "discounted_cash": 2857, "minimum": 454.38, "maximum": 6740.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3143.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6740.15, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4000.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4286.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6363.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2286.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2971.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3429.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2943.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6104.61, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4594.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3229.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perc Radiofreq Ablate Renal Tumor", "code_information": [ { "code": "50592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20995.7, "discounted_cash": 5947, "minimum": 776, "maximum": 16796.56, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6244.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6542.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14376.62, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8326.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8921.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13244.93, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4757.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6185.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7136.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6125.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6244.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12705.41, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9562.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6720.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS - SOI : 3", "code_information": [ { "code": "7213", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11439.18, "maximum": 12125.5308, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11439.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12125.53, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11439.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11439.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12011.14, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2098.94, "maximum": 2224.8764, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2098.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2224.88, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2098.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2098.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2203.89, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "REMOVAL OF BONE FOR GRAFT - 20902 - ", "code_information": [ { "code": "20902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6392, "discounted_cash": 7138, "minimum": 776, "maximum": 6392, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5710.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6392, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "discounted_cash": 9, "minimum": 7.376, "maximum": 40, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3106, "minimum": 22.5, "maximum": 10250.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7508.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6917.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% 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": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Mt-Phal Toe Disloc Wo Anes", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253, "discounted_cash": 242, "minimum": 43.9967, "maximum": 253, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 253 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 253 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 253 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 253 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 253, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 2", "code_information": [ { "code": "5302", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6921.91, "maximum": 7337.2246, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6921.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7337.22, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6921.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6921.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7268.01, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11790, "minimum": 5617.67, "maximum": 21826.95, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11200.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12969.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16815.21 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15327.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 15867.77 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10666.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21826.95 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8283.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10666.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17503.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11093.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 10666.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14148.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12144.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 12380.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11790.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11527.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10666.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 16498.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 12712.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10666.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11790.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5617.67 } ] } ] }, { "description": "Hc Assay Of Phenothiazine - G0480 - 30100385", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 918, "discounted_cash": 114, "minimum": 10.185, "maximum": 840, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 242.1, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Home Sleep Test/Type 4 Porta - 95801 - 74000026", "code_information": [ { "code": "95801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548, "discounted_cash": 58, "minimum": 36.76, "maximum": 438.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 216.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 164.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Lyme Dis Dna Dir Probe", "code_information": [ { "code": "87475", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.61, "discounted_cash": 20, "minimum": 16.04, "maximum": 196.488, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.42, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.66, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "675", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14803, "minimum": 11276.8283, "maximum": 27906.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14035.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16284.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21499.06 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19244.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20287.7 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13367.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27906.8 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13677.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13367.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20784.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13901.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 13367.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17764.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15247.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 15544.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14803.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23512.6 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13367.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 21093.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16253.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13367.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14803.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.84, "discounted_cash": 58, "minimum": 4.31, "maximum": 196.672, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.43 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC - SOI : 4", "code_information": [ { "code": "4664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15024.95, "maximum": 15926.447, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15024.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15926.45, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15024.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15024.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15776.2, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WO INFARCT - SOI : 1", "code_information": [ { "code": "0461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6175.76, "maximum": 6546.3056, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6546.31, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6484.55, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "727", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13468, "minimum": 10187.8937, "maximum": 25212.01, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12778.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14815.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19423.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17508.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18328.64 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25212.01 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13974.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 18589.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12657.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16161.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13872.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14141.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13468.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17424.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19056.75 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14683.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13468.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Chem Or Drugs", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232, "discounted_cash": 58, "minimum": 15, "maximum": 185.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 22.27 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Glucose Monitoring,72 Hrs,Sub-Q Sensor", "code_information": [ { "code": "95250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.05, "discounted_cash": 130, "minimum": 88.26, "maximum": 426.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 144.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.62, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.26 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.69, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 228.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 228.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 195.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.81, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.59, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 4", "code_information": [ { "code": "0454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17993.83, "maximum": 19073.4598, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 19073.46, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18893.52, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Prq Trluml Coronary Angioplasty Addl Branch", "code_information": [ { "code": "92921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4579, "minimum": 457.9, "maximum": 3663.2, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 } ] } ] }, { "description": "Hc Mra Abdomen W Contrast - C8900 - 61800001", "code_information": [ { "code": "C8900", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4700, "discounted_cash": 343, "minimum": 217.42, "maximum": 3760, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 405 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 405 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CCMCC", "code_information": [ { "code": "729", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9893, "minimum": 7273.5337, "maximum": 17999.84, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9415.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10883.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13866.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12861.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 13085.53 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17999.84 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8654.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14415.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9325.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8967.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11872.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10190.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 10388.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9893.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13054.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8967.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 13605.35 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10483.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9893.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Speech Audiometry, Complete", "code_information": [ { "code": "92556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 58, "minimum": 15, "maximum": 140.2749, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remove Impacted Ear Wax Uni", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.84, "discounted_cash": 58, "minimum": 9.6, "maximum": 245.84, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 245.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 245.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 245.84 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 245.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH CC", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10968, "minimum": 7049.82, "maximum": 20169.27, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 10427.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12065.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15538.16 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14259.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 14662.67 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9930.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20169.27 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10430.77 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9930.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14970.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 9930.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13162.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11297.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 11517.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10968.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7049.82 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9930.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 15245.14 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 11746.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9930.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10968.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TRANSIENT ISCHEMIA - SOI : 1", "code_information": [ { "code": "0471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5677.87, "maximum": 6018.5422, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5677.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6018.54, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5677.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5677.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5961.76, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [ { "code": "278", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47876, "minimum": 6441.28, "maximum": 94635.59, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 45154.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 52664.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 72906.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 62239.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 68798.23 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43004.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 94635.59 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 29088.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 43004.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 44724.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 43004.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 57451.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 49312.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 50270.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47876.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34862.4 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 43004.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 71531.24 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 55116.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43004.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 47876.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6441.28 } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19600, "minimum": 3888.67, "maximum": 37584.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 18548.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 21560.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28954.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25480.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 27323.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17665.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37584.25 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5035.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 17665.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 23225.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 18372.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 17665.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23520.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20188.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 20580.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19600.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3888.67 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 17665.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 28408.42 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 21889.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17665.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19600.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19499, "minimum": 4195.09, "maximum": 37381.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 18454.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 21449.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28798.57 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25349.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 27175.93 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17575.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37381.92 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 18397.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 17575.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 29379.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 18278.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 17575.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23399.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20084.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 20474.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19499.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26665.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 17575.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 28255.49 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 21771.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17575.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19499.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4195.09 } ] } ] }, { "description": "Hc Complex Drainage, Wound", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5040, "discounted_cash": 2857, "minimum": 776, "maximum": 5040, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3143.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5040, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4000.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4286.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5040, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2286.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2971.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3429.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2943.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5040, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4594.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3229.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Face <2.5 Cm", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1602.81, "discounted_cash": 399, "minimum": 278.7287, "maximum": 1602.81, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.32, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.96, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 451.9, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 439.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.7, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 559.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 599.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 319.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 479.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 411.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 419.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Braf Gene", "code_information": [ { "code": "81210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 894, "discounted_cash": 175, "minimum": 140.32, "maximum": 715.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 140.32 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 192.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 245.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 263.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 371.09, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 304.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 304.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 260.95 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 180.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 184.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 210.48, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.48, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 198.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Brain Combo", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4633.16, "discounted_cash": 343, "minimum": 269, "maximum": 3706.528, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1874.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1874.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 2060.6 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 1389.95, "10th_percentile": 1389.95, "90th_percentile": 1389.95, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cns Dna/Rna Amp Probe Multiple Subtypes 12-25", "code_information": [ { "code": "87483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1719, "discounted_cash": 416, "minimum": 287.3, "maximum": 1375.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 333.42 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 437.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 458.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 416.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 583.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 881.78, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 333.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 972.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 972.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 832.27 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 437.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 500.14 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 470.96, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ex For Speech Device Rx Init Hr", "code_information": [ { "code": "92607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 355, "discounted_cash": 125, "minimum": 61.7345, "maximum": 284, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 138.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 188.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 266.35, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 261.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 261.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 258.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.93, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 125.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 132.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 138.48, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 138.39, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 125.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Sciatic, Single", "code_information": [ { "code": "64445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2779.76, "discounted_cash": 694, "minimum": 23.5, "maximum": 2223.808, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 763.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1678.61, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 972.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1041.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 555.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 722.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 833.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 715.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 729.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1483.48, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1116.46, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "REHABILITATION - SOI : 2", "code_information": [ { "code": "8602", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11188.87, "maximum": 11860.2022, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11188.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11860.2, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11188.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11188.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11748.31, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 3", "code_information": [ { "code": "3833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7621.56, "maximum": 8078.8536, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7621.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8078.85, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7621.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7621.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8002.64, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "270", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45433, "minimum": 3512.91, "maximum": 89706.76, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 42856.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 49977.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 69108.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 59063.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 65215.07 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40815.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 89706.76 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3512.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 40815.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 61073.58 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 42448.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 40815.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 54520.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 46796.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 47705.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45433.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3901.49 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 40815.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 67805.73 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 52245.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40815.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 45433.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7278.09 } ] } ] }, { "description": "Hc Clsd Treat Sesamoid Fx", "code_information": [ { "code": "28530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 242, "minimum": 89.45, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.45 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Breast W/Out&With Contrast W/Cad Unilateral", "code_information": [ { "code": "77048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1472.2, "minimum": 220.54, "maximum": 1472.2, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1472.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1472.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1472.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 249.21 } ] } ] }, { "description": "MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE - SOI : 3", "code_information": [ { "code": "7403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19676.26, "maximum": 20856.8356, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19676.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 20856.84, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19676.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19676.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20660.07, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153, "discounted_cash": 14, "minimum": 8, "maximum": 122.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.58 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.48 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Radial Shaft Fx & Sital Disloc", "code_information": [ { "code": "25520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1581, "minimum": 776, "maximum": 4869.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1740.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3823.9, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2214.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3522.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1265.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1645.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1629.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3379.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1787.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Protein Tiss Western Blot, I&R", "code_information": [ { "code": "88371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.49, "discounted_cash": 22, "minimum": 9.147, "maximum": 30.49, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.78 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 30.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 30.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.12, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myelin Basic Protein,Csf", "code_information": [ { "code": "83873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 740, "discounted_cash": 17, "minimum": 13.76, "maximum": 592, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.39, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Labetalol Hcl Iv Soln 5 Mg/Ml - 00409226754", "drug_information": { "unit": 40, "type": "ML" }, "code_information": [ { "code": "00409226754", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [ { "code": "659", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22383, "minimum": 14926.18, "maximum": 43199.95, "payers_information": [ { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23055.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 23502.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22383.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25518.9 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 20159.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 32653.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 25159.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20159.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22383.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 21167.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 24621.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33280.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29098.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 31405.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20159.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43199.95 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14926.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 20159.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 33702.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 20965.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 20159.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26860.26, "additional_payer_notes": "120.00% 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": 22706, "minimum": 9345.91, "maximum": 43851.12, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 21471.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 24976.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33782.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29518.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 31878.91 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20448.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43851.12 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19049.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 20448.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 26479.33 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 21266.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 20448.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27247.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23387.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 23841.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22706.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20807.6 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 20448.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 33145.3 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 25539.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20448.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22706.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9345.91 } ] } ] }, { "description": "Hc Prosthetic Train Initial Enctr Ea 15 Min", "code_information": [ { "code": "97761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216, "discounted_cash": 41, "minimum": 33.392, "maximum": 180, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 45.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.31, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 80.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 41.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 45.91, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.37, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION - SOI : 4", "code_information": [ { "code": "4654", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15851.12, "maximum": 16802.1872, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15851.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16802.19, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15851.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15851.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16643.68, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "670", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9207, "minimum": 6714.2953, "maximum": 16615.89, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8769.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10128.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12800.68 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11970.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12079.43 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8352.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16615.89 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8298.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8352.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13025.95 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8686.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8352.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11049.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9483.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 9668.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9207.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11332.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8352.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 12559.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9677.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8352.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9207.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Small Bowel Endo To Ileum W Stent Place", "code_information": [ { "code": "44379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6618.67, "discounted_cash": 5972, "minimum": 776, "maximum": 6618.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6271.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6569.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4777.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6211.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6151.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6271.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SPLENIC PROCEDURES WITH CC", "code_information": [ { "code": "800", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24646, "minimum": 19301.2804, "maximum": 47764.94, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 23296.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 27110.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36797.52 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 32039.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 34724.18 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22187.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47764.94 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 20676.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 22187.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 32526.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 23074.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 22187.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29575.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 25385.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 25878.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24646.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45976.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 22187.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 36103.6 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 27818.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22187.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24646.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Proctosgmdsc Rigid Control Bleeding", "code_information": [ { "code": "45317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4683.45, "discounted_cash": 1177, "minimum": 83, "maximum": 3746.76, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1294.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2845.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1648.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1765.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.67, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 941.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1412.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1212.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2514.88, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1892.69, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1330.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Acute Gi Blood Loss Imaging", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1687.63, "discounted_cash": 393, "minimum": 39, "maximum": 1350.104, "payers_information": [ { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 875.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 314.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 452.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 497.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 409.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 471.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 840.16, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 632.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 444.41, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 432.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 950.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 550.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "URINARY STONES WITH MCC", "code_information": [ { "code": "693", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12301, "minimum": 9237.0511, "maximum": 22858.96, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11681.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 13532.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17610.26 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15992.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 16618.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11125.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22858.96 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9994.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11125.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17247.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11570.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 11125.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14762.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12671.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 12917.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12375.4 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11125.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 17278.17 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13313.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11125.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12301.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Tear Flow Exam", "code_information": [ { "code": "78660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 393, "minimum": 57.5, "maximum": 1865.248, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 432.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 950.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 550.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 875.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 314.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 270.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 297.05 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.95 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 409.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 471.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 840.16, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 632.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 444.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Xray Hips W Pelvis, Bilat =>5 Vw", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 800, "discounted_cash": 102, "minimum": 30.09, "maximum": 640, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 203.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 203.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 223.51 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay C-D Transfer Measure", "code_information": [ { "code": "82373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525, "discounted_cash": 18, "minimum": 7.96, "maximum": 420, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 31.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 26.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.67 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Diab Op Manage Group Per 30 Min", "code_information": [ { "code": "G0109", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110, "discounted_cash": 16, "minimum": 12.07, "maximum": 94, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.07 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.01, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 90 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Conization Of Cervix - 57522 - OR36057522", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6941.57, "discounted_cash": 3184, "minimum": 776, "maximum": 6941.57, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3343.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3503.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6941.57, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4458.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4776.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6941.57, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2547.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3311.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3821.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3343.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6803.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5120.09, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3598.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Removal of toe lesions - 28108 - ", "code_information": [ { "code": "28108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331, "discounted_cash": 1581, "minimum": 405.3609, "maximum": 2331, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1740.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2331, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2214.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2331, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2331, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1265.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1645.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1629.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2331, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2331, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1787.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13906, "minimum": 10545.1467, "maximum": 39568.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13191.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15297.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20104.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18078.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18971.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12563, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26096.11 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13486.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12563, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17699.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13065.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12563, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16687.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14323.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14601.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13906.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24875.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12563, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19725 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15198.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12563, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13906.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39568.16 } ] } ] }, { "description": "Hc Lymphangiography Extremity Only Bilateral Rs&I", "code_information": [ { "code": "75803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 1548, "minimum": 56.5, "maximum": 3831.128, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1626.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1703.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3743.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2168.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2322.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3448.73, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1238.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1610.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1858.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1595.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1626.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3308.25, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.78, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1749.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE - SOI : 1", "code_information": [ { "code": "7401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6696.22, "maximum": 7097.9932, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6696.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7097.99, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6696.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6696.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7031.03, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6030, "minimum": 4124.2111, "maximum": 10206.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 5780.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 6634, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7862.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 7840.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 7419.71 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5505.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10206.2 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4427.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 5505.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 8996.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 5725.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 5505.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 7237.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6211.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 6332.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6030.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5026.42 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 5505.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 7714.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 5944.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5505.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6030.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES - SOI : 1", "code_information": [ { "code": "3511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4497.43, "maximum": 4767.2758, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4497.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4767.28, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4497.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4497.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4722.3, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 4", "code_information": [ { "code": "0824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15663.73, "maximum": 16603.5538, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15663.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16603.55, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15663.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15663.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16446.92, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BWT 2000-2499G W RESP DIST SYNDOTH MAJ RESP COND - SOI : 2", "code_information": [ { "code": "6222", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17299.66, "maximum": 18337.6396, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17299.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18337.64, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17299.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17299.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18164.64, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Remove Pilonidal Cyst Exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7443, "discounted_cash": 2857, "minimum": 838, "maximum": 6907.5796, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3143.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6907.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4000.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4286.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6363.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2286.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2971.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3429.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2943.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 838 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6104.61, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4594.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3229.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY - SOI : 1", "code_information": [ { "code": "6111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12402.13, "maximum": 13146.2578, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12402.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13146.26, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12402.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12402.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13022.24, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITHOUT CCMCC", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13907, "minimum": 6749.58, "maximum": 26097.81, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18079.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18972.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26097.81 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12276.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20527.01 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13066.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12563.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16688.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14324.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14602.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13907.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16780 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12563.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19726.29 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15199.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13907.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6749.58 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13191.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15297.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20105.43 } ] } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS - SOI : 1", "code_information": [ { "code": "3441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5618.37, "maximum": 5955.4722, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5618.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5955.47, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5618.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5618.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5899.29, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [ { "code": "012", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36498, "minimum": 10541.67, "maximum": 71679.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 34449.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 40148.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55221.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 47448.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 52109.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 71679.72 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 27533.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 32808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 46441.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 34121.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 32808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 43798.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 37593.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 38323.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36498.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46799.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 32808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 54179.82 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41746.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 36498.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10541.67 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "819", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8218, "minimum": 5857.7, "maximum": 14619.87, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7839.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9040.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11262.97 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10683.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10628.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7465.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14619.87 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5857.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7465.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11566.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7764.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7465.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9862.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8465, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8629.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8218.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8871.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7465.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 11050.57 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8514.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7465.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8218.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Electrophys Ev,L A-V Pace/Rec,W/ Induct", "code_information": [ { "code": "93621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1380, "minimum": 239.982, "maximum": 1380, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1380 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1380 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1380 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1380 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1380 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1380 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1380 } ] } ] }, { "description": "Hc Nm Bone Imaging, Limited Area", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1659, "discounted_cash": 393, "minimum": 41.5, "maximum": 1327.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 432.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 950.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 550.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 875.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 314.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 301.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 301.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 331.84 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.99 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 409.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 471.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 840.16, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 632.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 444.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Revasc Intra Lithotrip-Ather", "code_information": [ { "code": "C9766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85888, "discounted_cash": 18034, "minimum": 1582, "maximum": 68710.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18935.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19837.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43593.77, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25247.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27051.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40162.16, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14427.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18755.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21641.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18575.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18935.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38526.21, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28994.76, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20378.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Slctv Cath Carotid/Innom Art Angio Xtrcranl Art", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12812.6, "discounted_cash": 3106, "minimum": 247.4, "maximum": 10250.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7508.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6917.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 247.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Phys Therapy Evaluation, 30 Min", "code_information": [ { "code": "97001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.75, "minimum": 18.675, "maximum": 180, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES - SOI : 4", "code_information": [ { "code": "0984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29625.87, "maximum": 31403.4222, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 29625.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 31403.42, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 29625.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29625.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31107.16, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR RESPIRATORY & CHEST PROCEDURES - SOI : 1", "code_information": [ { "code": "1201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14304.79, "maximum": 15163.0774, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14304.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15163.08, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14304.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14304.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15020.03, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Plasma Hemoglobin", "code_information": [ { "code": "83051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195, "discounted_cash": 7, "minimum": 3.5, "maximum": 156, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 16.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Myocardial Spect Single Study At Rest Or Stress", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3399, "discounted_cash": 1273, "minimum": 190.19, "maximum": 3078.7483, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1337.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1401, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3078.75, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1783.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1910.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.19 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2836.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1018.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1241.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1241.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1364.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1324.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1528.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1311.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1337.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2720.86, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2047.71, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1439.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PROCEDURES FOR OBESITY - SOI : 4", "code_information": [ { "code": "4034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34314.8, "maximum": 36373.688, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 34314.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 36373.69, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 34314.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34314.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 36030.54, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Program Eval Implantable In Prsn 1 Ld Pacemaker", "code_information": [ { "code": "93279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.1, "discounted_cash": 36, "minimum": 10.54, "maximum": 168.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 40.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.74, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.54 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.75, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 36.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 38.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.42, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.02, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.48, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colonoscopy Thru Stoma Bleed Control", "code_information": [ { "code": "44391", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3365.98, "discounted_cash": 1177, "minimum": 233.1, "maximum": 3365.98, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1294.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2845.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1648.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1765.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.67, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 941.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1412.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3365.98 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1212.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2514.88, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1892.69, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1330.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES - SOI : 2", "code_information": [ { "code": "0982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12061.54, "maximum": 12785.2324, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12061.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12785.23, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12061.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12061.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12664.62, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mopath Procedure Level 1", "code_information": [ { "code": "81400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 993, "discounted_cash": 63, "minimum": 44.1, "maximum": 794.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.17 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 70.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 89.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 135.32, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 99.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 85.58 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 67.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 76.75, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.75, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.27, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Endovasc Intracranial Prlng Admin Rx Agent, Addl", "code_information": [ { "code": "61651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4287.9, "minimum": 745.6658, "maximum": 4287.9, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4287.9 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4287.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "Hc Chromosome Analy:Amniotic", "code_information": [ { "code": "88269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3604, "discounted_cash": 173, "minimum": 138.928, "maximum": 2883.2, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 182.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 208.39 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 259.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.24, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 173.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 260.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.85 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 367.41, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 809.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 809.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 692.84 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR BILIARY TRACT PROCEDURES - SOI : 2", "code_information": [ { "code": "2612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17517.14, "maximum": 18568.1684, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17517.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18568.17, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17517.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17517.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18393, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cholecystostomy,Percutaneous, Complete", "code_information": [ { "code": "47490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13906.6, "discounted_cash": 3522, "minimum": 1582, "maximum": 11125.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3874.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8514.42, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4931.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5283.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7844.18, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2817.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4226.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3627.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3698.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7524.66, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5663.05, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3980.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Lipoprotein Bld By Nmr", "code_information": [ { "code": "83704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268, "discounted_cash": 34, "minimum": 23.6, "maximum": 214.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 37.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 47.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 72.34, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 73.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 41.03 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.63, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Manganese", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 576, "discounted_cash": 26, "minimum": 18.4, "maximum": 460.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.32 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 29.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 56.38, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 32.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 31.98 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Amputation thru metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2540.5, "discounted_cash": 3218, "minimum": 441.793, "maximum": 2540.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2540.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2540.5 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2540.5, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Lyme Dis Dna Amp Probe", "code_information": [ { "code": "87476", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 800, "discounted_cash": 35, "minimum": 28.07, "maximum": 640, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.77 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 74.24, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 129.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Treat Knee Fracture", "code_information": [ { "code": "27535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8913, "discounted_cash": 7138, "minimum": 1433.3, "maximum": 8913, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7495.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7852.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8913, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8913, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8913, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8913, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5710.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7424.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8566.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7352.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7495.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8913, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1433.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7138.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8066.48, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15052, "minimum": 8146.84, "maximum": 28408.36, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14269.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16557.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21885.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19568.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20652.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13590, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28408.36 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10543.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13590, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20616.12 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14133.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 13590, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18062.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15503.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 15805.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15052.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14305.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13590, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 21472.74 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16545.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13590, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15052.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8146.84 } ] } ] }, { "description": "Hc Lymphangiography Extremity Only Unilateral Rs&I", "code_information": [ { "code": "75801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 617, "minimum": 50, "maximum": 3831.128, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 647.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 678.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1491.75, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 863.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 925.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1374.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 493.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 740.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 635.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 647.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1318.34, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 992.18, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.35, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Serum Immunoelectrophoresis", "code_information": [ { "code": "86320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 539, "discounted_cash": 29, "minimum": 20, "maximum": 431.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.3, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NERVOUS SYSTEM MALIGNANCY - SOI : 4", "code_information": [ { "code": "0414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15472.92, "maximum": 16401.2952, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15472.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16401.3, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15472.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15472.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16246.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Arthrogram Of Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1348, "discounted_cash": 343, "minimum": 27.5, "maximum": 1078.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES - SOI : 3", "code_information": [ { "code": "0223", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20296.58, "maximum": 21514.3748, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20296.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21514.37, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 20296.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20296.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21311.41, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15531, "minimum": 6261.8, "maximum": 29374.06, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14719.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17084.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22629.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20190.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21354.37 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29374.06 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13081.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 23671.41 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14579.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 14018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18637.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15996.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 16307.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15531.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18116.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 22202.67 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17107.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15531.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6261.8 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "145", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11103, "minimum": 3844.55, "maximum": 20441.3, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 10553.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12214.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15747.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14434.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 14860.43 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20441.3 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3844.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13324.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11436.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 11658.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11103.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5295.65 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 15450.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 11905.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11103.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6777.1 } ] } ] }, { "description": "SYNCOPE & COLLAPSE - SOI : 1", "code_information": [ { "code": "2041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5084.23, "maximum": 5389.2838, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5084.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5389.28, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5084.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5084.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5338.44, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28382, "minimum": 6430.27, "maximum": 63119.3, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 26812.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 31220.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42605.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 36897.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 40204.61 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25535.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55303.55 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 24821.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 25535.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 44165.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 26556.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 25535.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 34058.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 29233.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 29801.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28382.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63119.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 25535.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 41801.73 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 32209.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25535.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28382.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6430.27 } ] } ] }, { "description": "Hc Bx Breast W Device Stereotact Guide Addl Lesion", "code_information": [ { "code": "19082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11453, "minimum": 70.38, "maximum": 9162.4, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION - SOI : 4", "code_information": [ { "code": "6254", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49416.35, "maximum": 52381.331, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 49416.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 52381.33, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 49416.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 49416.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 51887.17, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES - SOI : 2", "code_information": [ { "code": "3642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8484.66, "maximum": 8993.7396, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8484.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8993.74, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8484.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8484.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8908.89, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Revasc Iliac Art Angioplasty/Stnt Ea Add Vssl", "code_information": [ { "code": "37223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9856, "minimum": 191.3, "maximum": 7884.8, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.3 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.97 } ] } ] }, { "description": "Hc Ercp Dx Collection Specimen Brushing/Washing", "code_information": [ { "code": "43260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1575, "discounted_cash": 3792, "minimum": 273.8925, "maximum": 1575, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1575 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1575 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1575 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1575 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1575 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 410 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1575 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1575, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES - SOI : 3", "code_information": [ { "code": "5183", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18463, "maximum": 19570.78, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18463, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 19570.78, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 18463, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18463, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19386.15, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Nm Pulmonary Ventilation & Perfusion Imaging", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2172.63, "discounted_cash": 534, "minimum": 198.81, "maximum": 1738.104, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 587.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1291.22, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 747.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 801.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.81 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1189.57, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 427.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 469.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 469.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 516.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 210.74 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 640.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 550.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 560.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1141.12, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 858.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 603.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS - SOI : 4", "code_information": [ { "code": "1304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 41777.01, "maximum": 44283.6306, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 41777.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 44283.63, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 41777.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 41777.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 43865.86, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER SIGNIFICANT HIP & FEMUR SURGERY - SOI : 3", "code_information": [ { "code": "3093", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21007.85, "maximum": 22268.321, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 21007.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 22268.32, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 21007.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21007.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22058.24, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Propoxyphene Screening - G0480 - 30100029", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469.16, "discounted_cash": 114, "minimum": 10.185, "maximum": 840, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 242.1, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL & OTHER VASCULAR DISORDERS - SOI : 3", "code_information": [ { "code": "1973", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9414.1, "maximum": 9978.946, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9414.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9978.95, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9414.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9414.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9884.81, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Kit Gene Analysis Targeted Sequence Analysis", "code_information": [ { "code": "81272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 329, "minimum": 263.608, "maximum": 769.824, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 395.41, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 395.41, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 297.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 372.35, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 362.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 494.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 697.14, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 440.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 440.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 376.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 342.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 395.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 339.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 345.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Skin Benig <0.5 Cm Scalp/Neck/Hnd/Ft/Gent", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1145, "discounted_cash": 1624, "minimum": 199.1155, "maximum": 1145, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1145 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1145 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 572 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1145 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Vma", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408, "discounted_cash": 15, "minimum": 12, "maximum": 326.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 17.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.79, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 75.35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 64.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Vitrectomy, Laser Panretinal Coagulat, Pars Plana", "code_information": [ { "code": "67040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17093.8, "discounted_cash": 4066, "minimum": 776, "maximum": 13675.04, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4269.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4472.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9829.52, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5692.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6099.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4066.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9055.76, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3253.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 6568.56 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6568.56 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4066.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 6568.56 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4229, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 4066.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4188.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 4269.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4066.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4066.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8686.89, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6537.74, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4066.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4066.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4594.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ed Level 1", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630, "discounted_cash": 82, "minimum": 52.55, "maximum": 630, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 91.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200.51, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 116.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 124.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 334 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 184.73, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 630 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 630 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 630 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 387 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 82.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 99.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 380 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 87.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 177.2, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.36, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 82.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.73, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Typing Antigen System", "code_information": [ { "code": "86911", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.08, "minimum": 5, "maximum": 181.664, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "URETHRAL & TRANSURETHRAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7290.54, "maximum": 7727.9724, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7290.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7727.97, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7290.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7290.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7655.07, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Phenotype Dna Hiv W/Culture, First 10 Drugs", "code_information": [ { "code": "87903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3625, "discounted_cash": 488, "minimum": 390.928, "maximum": 2900, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 390.93 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 513.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 537.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 488.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 684.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 732.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 485.79 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1033.86, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 390.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2154.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2154.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1843.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 514.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 508.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 586.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 503.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 513.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 586.39 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 586.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 548.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 552.19, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SICKLE CELL ANEMIA CRISIS - SOI : 1", "code_information": [ { "code": "6621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4667.73, "maximum": 4947.7938, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4667.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4947.79, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4667.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4667.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4901.12, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Storage/Year Sperm/Semen", "code_information": [ { "code": "89343", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511, "discounted_cash": 167, "minimum": 88.8629, "maximum": 408.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 184.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 405.14, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 234.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 373.25, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 134.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 358.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.46, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 189.39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Indwel Cath Pleural Drain W Img", "code_information": [ { "code": "32557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6337, "discounted_cash": 1548, "minimum": 132.6, "maximum": 5069.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1626.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1703.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3743.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2168.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2322.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3448.73, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1238.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1610.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1858.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1595.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1626.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3308.25, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.78, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1749.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [ { "code": "256", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15279, "minimum": 7043.56, "maximum": 28867.41, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14483.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16807.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22239.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19863.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20986.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13793.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28867.41 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14136.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13793.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 22231.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14345.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 13793.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18335.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15738.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 16043.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15279.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20084.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13793.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 21819.71 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16812.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13793.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15279.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7043.56 } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA - SOI : 4", "code_information": [ { "code": "5134", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29871.4, "maximum": 31663.684, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 29871.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 31663.68, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 29871.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29871.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31364.97, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Tacrolimus", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516, "discounted_cash": 13, "minimum": 10.98, "maximum": 412.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.98 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.05, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 59.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 50.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.51, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12192, "minimum": 9147.7379, "maximum": 28244.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11578.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 13411.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17439.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15850.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 16457.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11027, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22637.94 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11332.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11027, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17293.51 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11468.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 11027, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14630.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12558.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 12802.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12192.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16390.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11027, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 17111.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13184.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11027, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12192.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28244.72 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 61413, "minimum": 36754.3, "maximum": 121949.03, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 57892.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 67555.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 93948.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 79837.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 88654.57 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55135.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 121949.03 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 36809.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 55135.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 70615.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 57341.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 55135.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 73696.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 63256.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 64484.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 61413.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36754.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 55135.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 92176.37 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 71024.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 55135.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 61413.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "715", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19825, "minimum": 15370.8103, "maximum": 38038.19, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 18760.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 21807.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29304.16 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25772.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 27653.03 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17867, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38038.19 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19030.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 17867, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 27638.84 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 18581.68, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 17867, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23790.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20420, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 20816.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19825.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26779.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 17867, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 28751.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 22153.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17867, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19825.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Gardner Vag Dna Dir Probe", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176, "discounted_cash": 20, "minimum": 16.04, "maximum": 140.8, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.66, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.42, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 1250-1499G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 2", "code_information": [ { "code": "6082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29512.34, "maximum": 31283.0804, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 29512.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 31283.08, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 29512.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29512.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30987.96, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "KIDNEY & URINARY TRACT MALIGNANCY - SOI : 3", "code_information": [ { "code": "4613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10539.15, "maximum": 11171.499, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10539.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11171.5, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10539.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10539.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11066.11, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "SPLENECTOMY - SOI : 2", "code_information": [ { "code": "6502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16377.05, "maximum": 17359.673, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16377.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 17359.67, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 16377.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16377.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17195.9, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8126, "minimum": 5832.8422, "maximum": 29945.88, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7752.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8939.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11120.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10564.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10493.64 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7383.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14434.55 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6154.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7383.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 12513.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7678.86, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7383.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9751.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8370.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8532.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8126.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8943.94 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7383.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10910.5 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8406.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7383.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8126.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29945.88 } ] } ] }, { "description": "Norepinephrine-Nacl Iv Solution 8 Mg/250Ml-0.9% - 69374050425", "drug_information": { "unit": 250, "type": "ML" }, "code_information": [ { "code": "69374050425", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "Hc Ro Inten Mod Radiother Plan W/Dose Vol Hist", "code_information": [ { "code": "77301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15300, "discounted_cash": 1361, "minimum": 707.83, "maximum": 12240, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1429.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1497.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3291.52, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1906.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2042.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 707.83 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3032.42, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1089.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 2514.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2514.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 2646.53 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 750.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1416.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1633.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1402.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1429.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 707.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2908.9, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2189.23, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 799.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1361.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1538.68, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400, "discounted_cash": 14, "minimum": 11.56, "maximum": 320, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.56 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.57, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 53.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [ { "code": "077", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11704.41, "maximum": 19925.57, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13025.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 19925.57 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18336.6 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11704.41 } ] } ] }, { "description": "Hc Ambl Bld Press W/Tape/Disk 24/>Hr Alys W/Reprt", "code_information": [ { "code": "93788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1839, "discounted_cash": 130, "minimum": 82.92, "maximum": 1471.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.49, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Radiation Physics Consult", "code_information": [ { "code": "77370", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 844, "discounted_cash": 132, "minimum": 96.5, "maximum": 675.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 145.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.61, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 185.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 198.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 294.45, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 347.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 347.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 365.88 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 158.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 136.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 138.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 282.46, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.58, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 149.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 4", "code_information": [ { "code": "0424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19871.18, "maximum": 21063.4508, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19871.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21063.45, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19871.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19871.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20864.74, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Rbc, Frz/Deg/Wsh, L/R, Irrad Per Unit", "code_information": [ { "code": "P9057", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1037.25, "discounted_cash": 420, "minimum": 30, "maximum": 1016.7576, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 441.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 462.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1016.76, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 588.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 630.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 936.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 336.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 435 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 435 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 435 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 437.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 504.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 433.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 441.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 898.56, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 676.26, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 475.3, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES - SOI : 3", "code_information": [ { "code": "2073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8307.53, "maximum": 8805.9818, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8307.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8805.98, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8307.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8307.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8722.91, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl In Nacl 0.9% Iv Soln 200 Mcg/50Ml", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "55150029601", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "PERM CARDIAC PACEMAKER IMPLANT WO AMI, HEART FAILURE OR SHOCK - SOI : 1", "code_information": [ { "code": "1711", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11571.86, "maximum": 12266.1716, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11571.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12266.17, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11571.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11571.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12150.45, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Trim Nail(S)", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.65, "discounted_cash": 58, "minimum": 18.0247, "maximum": 103.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 103.65, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 103.65, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 103.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 103.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 103.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 103.65, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 103.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM - SOI : 3", "code_information": [ { "code": "0583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12609.36, "maximum": 13365.9216, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12609.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13365.92, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12609.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12609.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13239.83, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Placement Ng/Og Tube By Physician", "code_information": [ { "code": "43752", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1051, "discounted_cash": 439, "minimum": 182.7689, "maximum": 1051, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 461.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 483.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1051, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 615.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 659.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1051 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 439.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 978.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 351.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 439.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1051 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 457.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 439.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 527.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 452.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 461.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 439.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 439.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 938.85, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 706.58, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1051 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 439.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 439.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 496.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tracheotomy Er Cricothroid Membrane", "code_information": [ { "code": "31605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1804, "discounted_cash": 233, "minimum": 186.4, "maximum": 1804, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 256.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 563.23, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 326.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 518.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 186.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1804 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1804 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1804 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1804 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 239.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 244.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 497.75, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 374.61, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1804 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 263.29, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inject Trigger Point1-2 Muscle", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1190.52, "discounted_cash": 301, "minimum": 207.0314, "maximum": 1190.52, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 332.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 729.92, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 422.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 452.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1190.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 672.46, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 241.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1190.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 362.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 311.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 317.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 645.07, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 485.48, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1190.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 301.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 341.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71, "discounted_cash": 7, "minimum": 5.5, "maximum": 56.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 10.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.56 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us,Transrectal,Prostate Vol", "code_information": [ { "code": "76873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1952, "discounted_cash": 102, "minimum": 65.15, "maximum": 1561.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 394.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 394.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 433.53 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Protein Tot Xcpt Refractometry Urine", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 3, "minimum": 2.936, "maximum": 80, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 2.94 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.1 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.4 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remvl Perm Pm Plse Gen W/Repl Plse Gen Sngl Ld", "code_information": [ { "code": "33227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28254, "discounted_cash": 8141, "minimum": 776, "maximum": 22603.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8548.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8955.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19679.37, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11397.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12211.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8141.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18130.25, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6512.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8141.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8466.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 8141.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9769.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8385.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 8548.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8141.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8141.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17391.74, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13088.99, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8141.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8141.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9199.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Chest Wo Contrast - C8910 - 61800005", "code_information": [ { "code": "C8910", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3154, "discounted_cash": 234, "minimum": 148.7, "maximum": 2523.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 258.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 567.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 328.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 343 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 343 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 501.43, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc External Ecg Rec>7D<15D Recording", "code_information": [ { "code": "93246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 278.3, "discounted_cash": 36, "minimum": 8.74, "maximum": 278.3, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.81, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.82, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 278.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 278.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.49, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chromosome Analy:Placenta", "code_information": [ { "code": "88267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2530, "discounted_cash": 188, "minimum": 150.856, "maximum": 2024, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 150.86 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 207.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 188.57 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 264, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 248.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 398.96, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 875.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 875.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 749.04 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 188.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 194.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 198, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 226.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 188.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.08, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 3", "code_information": [ { "code": "3413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8023.7, "maximum": 8505.122, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8023.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8505.12, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8023.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8023.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8424.89, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ugt1A1 Gene Analysis Common Variants", "code_information": [ { "code": "81350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906, "discounted_cash": 234, "minimum": 161.3, "maximum": 724.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 187.2 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 257.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 327.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 351, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 495.07, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 282.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 282.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 241.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.36, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 245.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 280.8, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.8, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 264.42, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OPEN EXTRACRANIAL VASCULAR PROCEDURES- SOI : 2", "code_information": [ { "code": "0242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10228.65, "maximum": 10842.369, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10228.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10842.37, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10228.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10228.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10740.08, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Ulna Shaft Fx Wo Amnip", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1610, "discounted_cash": 242, "minimum": 108, "maximum": 1610, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1610 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 4", "code_information": [ { "code": "7704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12267.4, "maximum": 13003.444, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12267.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13003.44, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12267.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12267.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12880.77, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Tympanometry & Reflex Thresh", "code_information": [ { "code": "92550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 212, "minimum": 16.25, "maximum": 519, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 233.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 513.46, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 297.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.25 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 473.04, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 218.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 223.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 453.77, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.51, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 240.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Total Testosterone", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219, "discounted_cash": 25, "minimum": 20.648, "maximum": 175.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.65 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.81 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.61, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 125.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 107.58 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 30.97 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Cath In Vein,Select", "code_information": [ { "code": "36011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1320, "minimum": 121.4, "maximum": 1320, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1320 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1320 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1320 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1320 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1320 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1320 } ] } ] }, { "description": "Hc Cytopath C/V Thin Layer Redo", "code_information": [ { "code": "88143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285, "discounted_cash": 23, "minimum": 15.9, "maximum": 228, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.43 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 25.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.75, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 101.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 86.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.65 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc H Pylori (C-13) Breath", "code_information": [ { "code": "83013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1890, "discounted_cash": 67, "minimum": 53.888, "maximum": 1512, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.51, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 187.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 160.57 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 67.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 70.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.83 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 67.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.12, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.89 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 74.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 67.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 94.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 101.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.1 } ] } ] }, { "description": "Hc General Health Panel", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520, "minimum": 36, "maximum": 416, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 103.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 88.31 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.6 } ] } ] }, { "description": "HEART &OR LUNG TRANSPLANT - SOI : 4", "code_information": [ { "code": "0024", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 241436.71, "maximum": 255922.9126, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 241436.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 255922.91, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 241436.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 241436.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 253508.55, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Removal of heel bone", "code_information": [ { "code": "28118", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3361.75, "discounted_cash": 3218, "minimum": 584.6083, "maximum": 3361.75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2575.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3361.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3361.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3361.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3361.75 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3315.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 832 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3361.75, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fats/Lipids, Feces, Quantitative", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 467, "discounted_cash": 16, "minimum": 4.02, "maximum": 373.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.54, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 70.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cyp2C19 Gene Analysis Common Variants", "code_information": [ { "code": "81225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 899, "discounted_cash": 291, "minimum": 200.8, "maximum": 719.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 233.09 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 320.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 407.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 437.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 616.43, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 496.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 496.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 424.78 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 349.63, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.63, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 329.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ORBIT AND EYE PROCEDURES - SOI : 2", "code_information": [ { "code": "0732", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10619.85, "maximum": 11257.041, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10619.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11257.04, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10619.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10619.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11150.84, "additional_payer_notes": "105% of State Medicaid 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": 24992, "minimum": 13090.66, "maximum": 48463.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 23622.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 27491.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37335.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 32490.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 35232.18 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48463.72 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 28312.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 22497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 33911.23 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 23397.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 22497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29990.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 25742.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 26242.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24992.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22263.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 22497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 36631.78 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 28225.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24992.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13090.66 } ] } ] }, { "description": "Hc Clsd Treat Mandible Fx Wo Manip", "code_information": [ { "code": "21450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2213.1, "discounted_cash": 530, "minimum": 135, "maximum": 2213.1, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 599.56, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 557.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 583.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1282.56, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 742.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 795.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1181.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 424.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 636.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 546.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 557.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1133.47, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 853.05, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ileocopy Thru Stoma W Blln Dilate", "code_information": [ { "code": "44381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890, "discounted_cash": 1887, "minimum": 454.38, "maximum": 2890, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2076.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2642.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1510.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1963.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2265.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1944.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2133.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Open/Perq Placement Intravascular Stent Ea Addl", "code_information": [ { "code": "37237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14619, "minimum": 189.4, "maximum": 11695.2, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 189.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "373", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7101, "minimum": 3729.33, "maximum": 12600, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6788.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7812.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9527.49 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9232.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8990.66 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12367.13 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4123.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10611.96 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6723.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6465.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8522.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7314.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7457.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7101.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6009.27 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6465.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9347.82 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7202.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7101.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3729.33 } ] } ] }, { "description": "Hc Pten Gene Analysis Duplication/Deletion Variant", "code_information": [ { "code": "81323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 569, "discounted_cash": 300, "minimum": 127.52, "maximum": 569, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 240 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 569, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 240, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 148.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 127.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 360, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 309, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 315, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 360, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 360, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 339, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4807, "minimum": 3126.6508, "maximum": 7737.53, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 4629.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 5288.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5960.9 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 6249.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 5625.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4409.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7737.53 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3790.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 4409.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7386.66 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 4585.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 4409.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 5768.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 4951.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 5047.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4807.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5237.96 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 4409.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 5848.49 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4506.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4409.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 4807.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5968.92 } ] } ] }, { "description": "Hc X-Ray Sacroiliac Jts 3+ Vw", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.55, "discounted_cash": 102, "minimum": 16.5, "maximum": 450.04, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 80.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 88.31 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mr Angio, Head", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2975.9, "discounted_cash": 234, "minimum": 187.776, "maximum": 2380.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 258.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 567.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 328.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 267.41 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1271.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.45 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 267.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 501.43, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 302.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ESOPHAGEAL DISORDERS - SOI : 2", "code_information": [ { "code": "2432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6300.92, "maximum": 6678.9752, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6300.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6678.98, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6300.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6300.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6615.97, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Coccidioides, Antibody", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240, "discounted_cash": 11, "minimum": 9.176, "maximum": 192, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.18 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 68.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Urethrocystogram & Voiding", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 912, "discounted_cash": 234, "minimum": 27.5, "maximum": 729.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 258.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 567.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 328.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 501.43, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR BILIARY TRACT PROCEDURES - SOI : 1", "code_information": [ { "code": "2611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12411.02, "maximum": 13155.6812, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12411.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13155.68, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12411.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12411.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13031.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES - SOI : 2", "code_information": [ { "code": "4202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5128, "maximum": 5435.68, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5128, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5435.68, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5128, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5128, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5384.4, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Oxycodone Screening - G0480 - 30100024", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469.16, "discounted_cash": 114, "minimum": 10.185, "maximum": 840, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 242.1, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Abdomen,Comp Acute Series", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 618.63, "discounted_cash": 102, "minimum": 24, "maximum": 494.904, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.09 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 107.09 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 117.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 3", "code_information": [ { "code": "4703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8925.79, "maximum": 9461.3374, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8925.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9461.34, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8925.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8925.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9372.08, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Image Fluid Collxn Drainag Cath Transrec/Vaginal", "code_information": [ { "code": "49407", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8656.34, "discounted_cash": 1624, "minimum": 184.87, "maximum": 6925.072, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3927.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2274.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2437.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 184.87 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3618.43, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 196 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3471.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2612.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fetal Chromosomal Microdeltj Genomic Seq Analys", "code_information": [ { "code": "81422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1462, "discounted_cash": 759, "minimum": 438.6, "maximum": 1462, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 910.86, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 523.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 857.73, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 607.24 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 797, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 834.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1062.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1138.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1462, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 607.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 789.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 910.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 781.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 797, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 910.86, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Lip,Full Thick,Vermilion", "code_information": [ { "code": "40650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5803, "discounted_cash": 530, "minimum": 424.464, "maximum": 4642.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 557.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 583.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1282.56, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 742.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 795.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1181.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 424.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 636.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 546.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 557.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1133.47, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 853.05, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 530.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 599.56, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6398.03, "maximum": 6781.9118, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6398.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6781.91, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6398.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6398.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6717.93, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Enzym", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 167, "minimum": 15, "maximum": 412.08, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 184.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 405.14, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 234.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 373.25, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 134.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 22.27 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 358.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.46, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 189.39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Trach Stent", "code_information": [ { "code": "31631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15451.8, "discounted_cash": 6942, "minimum": 1582, "maximum": 15451.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7290.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7637.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9720.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10414.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5554.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7220.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8331.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7290.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14832.11, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11162.62, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7845.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "RENAL DIALYSIS ACCESS DEVICE PROCEDURES- SOI : 1", "code_information": [ { "code": "4441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9797.78, "maximum": 10385.6468, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9797.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10385.65, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9797.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9797.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10287.67, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Inj W Fluor Eval Cv Device", "code_information": [ { "code": "36598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 935.9, "discounted_cash": 209, "minimum": 162.753, "maximum": 935.9, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 230.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 505.82, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 292.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 313.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 466, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 219.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 447.02, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.42, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 935.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 209.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 236.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &OR D&C - SOI : 2", "code_information": [ { "code": "5422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3653.48, "maximum": 3872.6888, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3653.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3872.69, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3653.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3653.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3836.15, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Epi Autogrft Face/Nck/Hnd/Ft/Gen <100 Sqcm", "code_information": [ { "code": "15115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7138.85, "discounted_cash": 2029, "minimum": 776, "maximum": 5711.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2131.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2232.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4906.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2841.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3044.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4520.36, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1623.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2110.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2435.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2090.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2131.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4336.23, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2293.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSION - SOI : 2", "code_information": [ { "code": "1992", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5291.46, "maximum": 5608.9476, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5291.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5608.95, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5291.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5291.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5556.03, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Theraputic Apheresis, Rbc", "code_information": [ { "code": "36512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4590, "discounted_cash": 1532, "minimum": 50, "maximum": 3703.6643, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1608.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1685.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3703.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2145.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2298.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1532.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3412.12, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1225.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1637 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1637 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1532.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1637 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1593.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1532.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1838.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1578.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1608.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1532.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3273.13, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2463.35, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1532.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1532.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1731.34, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Apply Intrcav Radiat Interm", "code_information": [ { "code": "77762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3462.41, "discounted_cash": 543, "minimum": 129.55, "maximum": 2769.928, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 570.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 597.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1313.96, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 761, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 815.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.55 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1210.53, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 434.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 317.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 334.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 565.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 652.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 559.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 570.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1161.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 873.93, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient New Sf Mdm 15-29 Minutes - G0463 - 76100002", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 531.36, "discounted_cash": 130, "minimum": 32.1715, "maximum": 999.304, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 144.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.62, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.69, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.81, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.59, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 2", "code_information": [ { "code": "1772", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15433.25, "maximum": 16359.245, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15433.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16359.25, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15433.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15433.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16204.91, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CCMCC", "code_information": [ { "code": "804", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12398, "minimum": 7650, "maximum": 23054.48, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11772.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 13638.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17760.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16118.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 16760.16 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11212, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23054.48 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13462.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11212, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16156.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11660.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 11212, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14878.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12770.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 13018.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12398.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12372.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11212, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 17425.96 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13427.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11212, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12398.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphatase Acid Prostatic", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70, "discounted_cash": 9, "minimum": 7.728, "maximum": 56, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.73 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "517", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13921, "minimum": 10350, "maximum": 26126.71, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13205.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15313.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20127.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18098.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18993.61 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12576.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26126.71 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15849.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12576.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17919.58 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13079.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12576.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16705.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14339.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14617.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13921.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18969 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12576.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19748.13 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15216.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12576.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13921.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Narcosynthesis", "code_information": [ { "code": "90865", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.05, "discounted_cash": 174, "minimum": 109.5657, "maximum": 504.04, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 183.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 192.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 422.08, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 244.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 388.86, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 183.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 373.02, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.73, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 197.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Comparative Analysis Str Markers Patient&Comp Spec", "code_information": [ { "code": "81265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1574.04, "discounted_cash": 233, "minimum": 160.7, "maximum": 1259.232, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 186.46 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 256.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.07, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 326.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 493.11, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 186.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 498.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 498.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 427.08 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 233.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 240.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 244.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.68, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.68, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 233.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 263.37, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [ { "code": "641", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7530, "minimum": 5258.1, "maximum": 13230.82, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7191.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8283, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10192.86 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9789, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9618.55 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6848.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13230.82 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5258.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6848.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10545.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7122.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6848.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9036, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7755.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7906.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7530, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6693 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6848.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10000.65 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7705.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6848.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7530, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "423", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35968, "minimum": 17447.6, "maximum": 70608.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 33949.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 39564.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54395.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 46758.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 51331.08 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32333.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70608.6 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 64300.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 32333.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 47993.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 33626.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 32333.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 43161.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 37047.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 37766.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35968.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65276.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 32333.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 53370.2 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41123.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32333.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 35968.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17447.6 } ] } ] }, { "description": "Hc Clsd Treat Metatarsal Fx W Manip", "code_information": [ { "code": "28475", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2381, "discounted_cash": 242, "minimum": 118, "maximum": 2040, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Femoral, Continu W Cath", "code_information": [ { "code": "64448", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 870, "minimum": 73.22, "maximum": 2555.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 957.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2103.33, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1218.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1305.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.22 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1937.76, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 896.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1858.83, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1398.95, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 983.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS WITH CC", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11895, "minimum": 8864.22, "maximum": 22039.47, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11299.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 13085.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16978.94 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15464.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 16022.27 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10761.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22039.47 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8864.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10761.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16934.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11191.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 10761.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14274.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12252.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 12490.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11895.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9667.19 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10761.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 16658.75 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 12835.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10761.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11895.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS - SOI : 2", "code_information": [ { "code": "8612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5325.65, "maximum": 5645.189, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5325.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5645.19, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5325.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5325.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5591.93, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drug Screening Pregabalin - G0480 - 30180366", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469.16, "discounted_cash": 114, "minimum": 10.185, "maximum": 840, "payers_information": [ { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 242.1, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 } ] } ] }, { "description": "Hc Prq Trluml Coronary Stent W/Angio One Art/Brnch - 92928 - 48100127", "code_information": [ { "code": "92928", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35672.8, "discounted_cash": 11356, "minimum": 1582, "maximum": 35376.64, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11924.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12492.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27452.79, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15899.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17035.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25291.77, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9085.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11811.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13628.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11697.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 11924.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24261.54, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18259.19, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12833.27, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "738", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13346, "minimum": 9900, "maximum": 24967.19, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12664.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14681.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19234.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17350.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18150.66 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12061.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24967.19 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12346.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12061.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 18053.23 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12544.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12061.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16016.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13747.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14014.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13346.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16514 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12061.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 18871.69 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14541.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12061.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13346.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8905.56, "discounted_cash": 5274, "minimum": 776, "maximum": 8905.56, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5538.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5802.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8905.56, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7384.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7912.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5274.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8905.56, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4219.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 4816.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4816.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5274.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3816.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5485.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5274.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6329.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5433.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5538.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5274.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5274.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8905.56, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8480.64, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5274.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5274.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5960.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19652.33, "maximum": 20831.4698, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19652.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 20831.47, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19652.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19652.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20634.95, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 3", "code_information": [ { "code": "1323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9738.28, "maximum": 10322.5768, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9738.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10322.58, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9738.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9738.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10225.19, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER INFECTIOUS & PARASITIC DISEASES - SOI : 1", "code_information": [ { "code": "7241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4192.41, "maximum": 4443.9546, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4192.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4443.95, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4192.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4192.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4402.03, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "REHABILITATION - SOI : 3", "code_information": [ { "code": "8603", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14849.87, "maximum": 15740.8622, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14849.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15740.86, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14849.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14849.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15592.36, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Infect Agent Dna/Rna Influenza >2 Types, Ea Add", "code_information": [ { "code": "87503", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.01, "discounted_cash": 29, "minimum": 23.376, "maximum": 226.408, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.38 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 61.82, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Phys/Qhp Education Svcs Rendered Pts Grp Setting", "code_information": [ { "code": "99078", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410, "minimum": 71.299, "maximum": 328, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 90 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM PROCEDURES - SOI : 2", "code_information": [ { "code": "1802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12616.88, "maximum": 13373.8928, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12616.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13373.89, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12616.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12616.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13247.72, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 3", "code_information": [ { "code": "5173", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12938.32, "maximum": 13714.6192, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12938.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13714.62, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12938.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12938.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13585.24, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Reagent Strip/Blood Glucose", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34, "discounted_cash": 5, "minimum": 2, "maximum": 27.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.05 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Revasc Chro Add - C9608 - 48100200", "code_information": [ { "code": "C9608", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10388, "minimum": 1582, "maximum": 8310.4, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "Rpr aa hrn rcr < 3 rdc", "code_information": [ { "code": "49613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8242, "discounted_cash": 3522, "minimum": 776, "maximum": 8242, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3874.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8242, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4931.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5283.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7844.18, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2817.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4226.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3627.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3698.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7524.66, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5663.05, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3980.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fecal Microbiota Prep And Instillation - 44705 - 75000127", "code_information": [ { "code": "44705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2235.82, "minimum": 65.4, "maximum": 2235.82, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2235.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.69 } ] } ] }, { "description": "Hc X-Ray Pelvis 1/2 Vw", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.55, "discounted_cash": 102, "minimum": 10, "maximum": 450.04, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 65.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 72.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32029.84, "maximum": 33951.6304, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 32029.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 33951.63, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 32029.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32029.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33631.33, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Family Psytx W/O Patient", "code_information": [ { "code": "90846", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 750, "discounted_cash": 174, "minimum": 110.62, "maximum": 600, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 183.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 192.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 422.08, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 244.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 388.86, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 183.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 373.02, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.73, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 197.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE - SOI : 1", "code_information": [ { "code": "6301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20477.81, "maximum": 21706.4786, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20477.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21706.48, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 20477.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20477.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21501.7, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Replace Picc W Port Or Pump", "code_information": [ { "code": "36585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4596, "discounted_cash": 3106, "minimum": 799.2444, "maximum": 4596, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4596, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4596, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4596, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4596, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4596, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Insert Tunneled Cv Cath - 36558 - OR36036558", "code_information": [ { "code": "36558", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843, "discounted_cash": 3106, "minimum": 1189.9977, "maximum": 10250.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6843, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6843, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24491, "minimum": 19175.5548, "maximum": 47453.81, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36557.83 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31839.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 34498 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22049, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47453.81 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 23120.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 22049, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 31769.24 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 22930.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 22049, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29390.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 25226.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 25716.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24491.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31383.9 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 22049, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 35868.43 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 27637.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22049, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24491.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 23151.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 26941.08, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "663", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13782, "minimum": 10444.154, "maximum": 25846.18, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13074.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15160.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19911.58 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17917.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18789.67 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12452, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25846.18 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12578.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12452, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20960.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12950.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12452, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16539.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14196.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14471.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13782.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14069.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12452, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19536.09 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15053.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12452, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13782.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Breast Uni Wo Contrast - C8904 - 61000031", "code_information": [ { "code": "C8904", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3033, "discounted_cash": 275, "minimum": 220.624, "maximum": 2426.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 303.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 666.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 386.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 413.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 614.16, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 220.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 275.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 284.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 289.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 589.14, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 443.39, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 275.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 311.63, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "POSTPARTUM & POST ABORTION DIAGNOSES WO PROCEDURE - SOI : 3", "code_information": [ { "code": "5613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6219.53, "maximum": 6592.7018, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6219.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6592.7, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6219.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6219.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6530.51, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9525, "minimum": 6029.34, "maximum": 17256.86, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9068.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10477.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13294.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12383.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12545.4 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8637.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17256.86 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6029.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8637.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13780.98 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8982.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8637.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11430.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9811.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 10001.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9525.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9266.58 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8637.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 13043.77 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10050.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8637.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9525.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 12.5-20 Cm", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1602.81, "discounted_cash": 399, "minimum": 278.7287, "maximum": 1602.81, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 439.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.7, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 559.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 599.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 319.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 479.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 411.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 419.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.32, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.96, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 451.9, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carnitine", "code_information": [ { "code": "82379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150, "discounted_cash": 16, "minimum": 11.6, "maximum": 120, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.69, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 72.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 62.35 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Test For Urine Cystines", "code_information": [ { "code": "82615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.32, "discounted_cash": 9, "minimum": 5, "maximum": 97.856, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 32.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": 31018, "minimum": 17161.32, "maximum": 62308.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 29292.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 34120.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46702.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 40323.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 44070.82 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27897.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60621.73 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 45824.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 27897.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 49171.29 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 29013.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 27897.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37221.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 31948.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 32569.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31018.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62308.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 27897.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 45821.53 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 35306.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27897.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31018.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17161.32 } ] } ] }, { "description": "Hc Colonoscopy Thru Stoma Lesion/Tumor Remov Snare", "code_information": [ { "code": "44394", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904.8, "discounted_cash": 1177, "minimum": 505.1447, "maximum": 2904.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1294.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2845.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1648.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1765.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.67, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 941.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1412.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1212.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2514.88, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1892.69, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1330.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colorectal Cancer Screen, Sigmoid, Ba Enema - 74270 - 32000239", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1905, "discounted_cash": 172, "minimum": 22.5, "maximum": 1524, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 189.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 417.1, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 241.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 384.27, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 243.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 267.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 181.18, "additional_payer_notes": "105.00% 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": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.42, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 194.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Septoplasty/Submucous Resecj W/Wo Cartilage Grf", "code_information": [ { "code": "30520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10995.3, "discounted_cash": 3261, "minimum": 823, "maximum": 8796.24, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3587.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7884.36, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4566.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7263.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2609.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3392.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3913.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3359.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3424.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 823 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6967.84, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5243.98, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3685.68, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Valproate Sodium Inj 100 Mg/Ml - 63323049401", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "63323049401", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "Hc Incision & Drain Of Hematoma/Fluid", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6516.99, "discounted_cash": 1624, "minimum": 619, "maximum": 11194.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3927.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2274.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2437.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3618.43, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 619 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3471.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2612.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Heart Flow Reserv Measure Ea Add Vessl", "code_information": [ { "code": "93572", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3414, "minimum": 593.6946, "maximum": 3414, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3414 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "Hc Ro Radn Rx Delivery >=1 Mev Complx", "code_information": [ { "code": "77412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1367, "discounted_cash": 543, "minimum": 44, "maximum": 1313.9625, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 570.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 597.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1313.96, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 761, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 815.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1210.53, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 434.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 312.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 312.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 329.29 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 565.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 652.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 559.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 570.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1161.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 873.93, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 543.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 614.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Glucose Blood Test", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35, "discounted_cash": 3, "minimum": 2, "maximum": 28, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.94 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.71, "additional_payer_notes": "113.00% 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": 21695, "minimum": 16895.3188, "maximum": 41810.9, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 20519.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 23864.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32210.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28203.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 30395.71 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19542.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41810.9 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19542.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 19542.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 28451.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 20324.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 19542.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26034.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22345.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 22779.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21695.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21293.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 19542.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 31603.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 24351 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19542.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21695.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24473.55 } ] } ] }, { "description": "Hc Repr Wnd Intrmd Face >30.1 Cm", "code_information": [ { "code": "12057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5490, "discounted_cash": 399, "minimum": 319.928, "maximum": 4392, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 439.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.7, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 559.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 599.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 319.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 479.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 411.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 419.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.32, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.96, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 451.9, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PNEUMONIA - SOI : 1", "code_information": [ { "code": "1391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3697.93, "maximum": 3919.8058, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3697.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3919.81, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3697.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3697.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3882.83, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Small Bowel Endo Ablate Lesn", "code_information": [ { "code": "44369", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 1887, "minimum": 220, "maximum": 3575.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2076.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2642.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1510.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1963.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2265.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1944.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3035.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2133.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6942, "minimum": 4867.5721, "maximum": 12184.47, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6638.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7636.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9279.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9025.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8757.06 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6322.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12045.8 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6197.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6322.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9683.41 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6575.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6322.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8331.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7150.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7289.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6226.15 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6322.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9104.93 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7015.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6322.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12184.47 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28025, "minimum": 7130.55, "maximum": 54582.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 26476.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 30827.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42049.82 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 36432.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 39680.54 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25215.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54582.68 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22797.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 25215.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 26223.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 25215.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33630.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28865.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 29426.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28025.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33939.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 25215.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 41256.85 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 31789.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25215.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28025.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7130.55 } ] } ] }, { "description": "PLEURAL EFFUSION WITH CC", "code_information": [ { "code": "187", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9307, "minimum": 6795.3643, "maximum": 16816.51, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10237.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12955.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12099.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12225.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8441.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16816.51 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6908.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8441.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14086.98 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8779.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8441.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11168.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9586.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 9772.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9307.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9510.15 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8441.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 12710.92 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9794.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8441.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9307.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6991.81 } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CCMCC", "code_information": [ { "code": "735", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12310, "minimum": 7200, "maximum": 22875.96, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11689.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 13541.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17623.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16003.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 16630.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11132.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22875.96 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13525.82 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11132.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17733.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11578.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 11132.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14772.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12679.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 12925.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12310.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14394.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11132.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 17291.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13323.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11132.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12310.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39285, "minimum": 6072.42, "maximum": 77302.22, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 37071.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 43214.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59552.68 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 51071.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 56197.21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35306.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 77302.22 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 35614.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 35306.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 51879.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 36718.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 35306.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 47142.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 40464.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 41249.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45642.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 35306.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 58429.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45021.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35306.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 39285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6072.42 } ] } ] }, { "description": "OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES - SOI : 2", "code_information": [ { "code": "8152", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5336.6, "maximum": 5656.796, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5336.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5656.8, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5336.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5336.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5603.43, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BWT 1000-1249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM - SOI : 2", "code_information": [ { "code": "6022", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 62273.29, "maximum": 66009.6874, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 62273.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 66009.69, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 62273.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 62273.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 65386.95, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Knee Disloc W Anes", "code_information": [ { "code": "27552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1581, "minimum": 157, "maximum": 4869.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1740.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3823.9, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2214.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3522.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1265.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1645.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1629.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3379.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1787.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 4", "code_information": [ { "code": "6614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19828.09, "maximum": 21017.7754, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19828.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21017.78, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19828.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19828.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20819.49, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Hiv 1 Genotype, Dna/Rna, Other Regions", "code_information": [ { "code": "87906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2075, "discounted_cash": 128, "minimum": 102.98, "maximum": 1660, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.98 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 141.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 180.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 193.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.91 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 272.35, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1161.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1161.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 994.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 132.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 135.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 154.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.46, "additional_payer_notes": "113.00% 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": 44499.68, "maximum": 47169.6608, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 44499.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 47169.66, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 44499.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 44499.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 46724.66, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Phenotype Infect Agent Drug", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 130, "minimum": 30, "maximum": 100, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Plcmt Bile Duct Stent,New Access Wo Sep Cath", "code_information": [ { "code": "47539", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13074, "discounted_cash": 5947, "minimum": 776, "maximum": 13074, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6244.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6542.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13074, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8326.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8921.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13074, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4757.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 5089 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6185.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7136.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6125.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6244.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12705.41, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9562.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6720.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "TONSIL & ADENOID PROCEDURES - SOI : 1", "code_information": [ { "code": "0971", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5060.29, "maximum": 5363.9074, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5060.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5363.91, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5060.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5060.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.3, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Intra-Atrial Recording", "code_information": [ { "code": "93602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4171, "discounted_cash": 7673, "minimum": 725.3369, "maximum": 4171, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1235.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1235.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1223.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4171, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphohexose Enzymes", "code_information": [ { "code": "84087", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.55, "discounted_cash": 10, "minimum": 8.58, "maximum": 123.64, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.58 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.27 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.7, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 48.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213, "discounted_cash": 9, "minimum": 7.768, "maximum": 170.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 49.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 42.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mthfr Gene", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380, "discounted_cash": 65, "minimum": 45, "maximum": 304, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.27 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 71.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 91.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 138.24, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 101.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 87.16 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 68.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.41, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78.41, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Type Antigen Donor Reagent Serum, Ea Ag", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1444.84, "discounted_cash": 352, "minimum": 2.82, "maximum": 1155.872, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 387.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 852.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 493.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 528.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 785.28, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 39.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 423.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 363.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 370.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 753.3, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 566.93, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.46, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Guide Rad Therapy Fields", "code_information": [ { "code": "77387", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 754, "minimum": 63.81, "maximum": 603.2, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 173.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 182.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.64 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.11 } ] } ] }, { "description": "Hc Ct Scan Abdomen/Pelvis W Contrast", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4200, "discounted_cash": 343, "minimum": 192.73, "maximum": 3360, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 192.73 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 771.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 771.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 848.32 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 1259.99, "10th_percentile": 1259.99, "90th_percentile": 1260.01, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.29 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 192.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Iridotomy/Irridectomy Laser Surg Per Session", "code_information": [ { "code": "66761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2349.35, "discounted_cash": 541, "minimum": 408.552, "maximum": 2349.35, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 568.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 595.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1307.92, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 757.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 811.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 541.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1204.96, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 432.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 541.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2349.35 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 541.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 649.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 557.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 568.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 795 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 541.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 541.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1155.88, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 869.91, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 541.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 541.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 611.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3340.93, "maximum": 3541.3858, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3340.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3541.39, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3340.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3340.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3507.98, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ercp Biliary/Panc Duct Stent Exchnge W/Dil&Wire", "code_information": [ { "code": "43276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6618.67, "discounted_cash": 5972, "minimum": 776, "maximum": 6618.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6271.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6569.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4777.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6211.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6151.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6271.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5972.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [ { "code": "564", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13979, "minimum": 10604.9179, "maximum": 26244.02, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13260.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15377.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20218.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18173.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 19078.9 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12628.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26244.02 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 17615.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12628.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20162.39 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13133.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12628.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16775.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14399.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14678.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13979.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19268.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12628.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19836.8 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15284.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12628.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13979.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6773, "minimum": 3791.74, "maximum": 11704.06, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7450.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9016.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8805.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8508.62 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11704.06 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3791.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10014.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6417.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6170.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8127.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6976.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7111.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6773.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6421.64 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6170.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 8846.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 6816.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6773.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 58929, "minimum": 9200.57, "maximum": 116936.89, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 55555.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 64822.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 90086.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 76608.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 85010.84 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 52909.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 116936.89 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12932.45 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 52909.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 80324.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 55026.19, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 52909.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 70715.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 60697.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 61876.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58929.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16119.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 52909.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 88387.89 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 68104.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 52909.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 58929.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9200.57 } ] } ] }, { "description": "Hc Flt3 Gene Anlys Tyrosine Kinase Domain Variants", "code_information": [ { "code": "81246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 474.21, "discounted_cash": 83, "minimum": 57.2, "maximum": 379.368, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.4 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 91.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 83, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 116.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 124.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 175.6, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 142.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 121.74 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 99.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 87.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 99.6, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 99.6, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.79, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strapping Of Ankle And/Or Ft", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 633.37, "discounted_cash": 159, "minimum": 20, "maximum": 633.37, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 175.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 386.43, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 223.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 239.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 356.01, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 354.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 354.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 350.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 164.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 167.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.51, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 257.02, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 633.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 180.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 3", "code_information": [ { "code": "0563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11539.03, "maximum": 12231.3718, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11539.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12231.37, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11539.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11539.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12115.98, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Esomeprazole Sodium For Intravenous Soln 40 Mg (Base Equiv) - 55150018505", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "55150018505", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES - SOI : 2", "code_information": [ { "code": "4412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20336.24, "maximum": 21556.4144, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20336.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21556.41, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 20336.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20336.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21353.05, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11248, "minimum": 8378.2699, "maximum": 20733.73, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 10690.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12373.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15973.01 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14623.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 15073.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20733.73 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19878.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 15946.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10588.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 10181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13498.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11586.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 11811.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11248.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15068.6 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 15671.79 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 12075.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11248.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9051, "minimum": 6547.38, "maximum": 16301.35, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8623.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9957.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12558.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11767.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11850.77 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8212.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16301.35 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6547.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8212.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 12289.67 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8541.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8212.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10862.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9323.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 9504.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9051.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10613.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8212.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 12321.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9494.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8212.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9051.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Occult Blood Other Sources", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.23, "discounted_cash": 5, "minimum": 3.63, "maximum": 56.184, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.26 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.63 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hep B Core Ab Test, Total", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572, "discounted_cash": 12, "minimum": 9.64, "maximum": 457.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 52.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 44.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65395, "minimum": 20976.54, "maximum": 129982.39, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20976.54 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 61639.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 71934.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 100136.83 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 85014.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 94494.67 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 58703.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 129982.39 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 58490.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 58703.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 91274.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 61052.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 58703.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 78474.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 67357.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 68665.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65395.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 83836.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 58703.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 98248.47 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 75702.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 58703.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 65395.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [ { "code": "808", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19577, "minimum": 15168.825, "maximum": 37538.34, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 18527.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 21535.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28919.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25450.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 27289.64 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17645, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37538.34 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16898.94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 17645, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 26927.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 18350.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 17645, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23493, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20164.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 20556.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19577.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18826.9 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 17645, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 28373.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 21862.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17645, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19577.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Detect Agent,Immun,Dir Obs, Rsv", "code_information": [ { "code": "87807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.71, "discounted_cash": 13, "minimum": 10.48, "maximum": 47.59, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.72, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Autoimmune Rheumatoid Arthr, 12 Biomark", "code_information": [ { "code": "81490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39, "discounted_cash": 840, "minimum": 11.7, "maximum": 39, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [ { "code": "687", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9801, "minimum": 5904.3, "maximum": 17814.52, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9328.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10781.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13724.08 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12742.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12950.81 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17814.52 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5904.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14083.46 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9240.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8884.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11762.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10095.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 10291.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9801.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12257.9 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8884.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 13465.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10375.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9801.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS - SOI : 3", "code_information": [ { "code": "3443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11208.02, "maximum": 11880.5012, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11208.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11880.5, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11208.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11208.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11768.42, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS - SOI : 1", "code_information": [ { "code": "4681", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4253.27, "maximum": 4508.4662, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4253.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4508.47, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4253.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4253.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4465.93, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Etomidate Iv Soln 2 Mg/Ml - 00409669502", "drug_information": { "unit": 20, "type": "ML" }, "code_information": [ { "code": "00409669502", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 1", "code_information": [ { "code": "5171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6334.43, "maximum": 6714.4958, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6334.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6714.5, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6334.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6334.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6651.15, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Inpt/Ed Teleconsult50", "code_information": [ { "code": "G0426", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186, "minimum": 32.3454, "maximum": 186, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 186 } ] } ] }, { "description": "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES - SOI : 4", "code_information": [ { "code": "3474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16413.3, "maximum": 17398.098, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16413.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 17398.1, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 16413.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16413.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17233.97, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Split Grft,Trunk,Arm,Leg Ea 100 Sqcm", "code_information": [ { "code": "15101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2925, "minimum": 508.6575, "maximum": 2925, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2925 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2925 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2925 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "Hc Clsd Treat Dental Ridge Fx", "code_information": [ { "code": "21440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 3261, "minimum": 1890.0322, "maximum": 8694.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3587.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7884.36, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4566.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4892.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7263.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2609.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3392.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3913.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3359.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3424.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6967.84, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5243.98, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3261.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3685.68, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER INFECTIOUS & PARASITIC DISEASES - SOI : 3", "code_information": [ { "code": "7243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9504.38, "maximum": 10074.6428, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9504.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10074.64, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9504.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9504.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9979.6, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent <2.5 Cm", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149, "discounted_cash": 399, "minimum": 25.9111, "maximum": 149, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 149 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 149 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 149 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 149 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 149 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 149 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 149, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Head Combo", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2922.8, "discounted_cash": 172, "minimum": 100, "maximum": 2338.24, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 189.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 417.1, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 241.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 384.27, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 793.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 793.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 872.41 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 181.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.42, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 194.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES - SOI : 4", "code_information": [ { "code": "4204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14576.99, "maximum": 15451.6094, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14576.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15451.61, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14576.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14576.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15305.84, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Igk@ Gene Rearrange Detect Abnormal Clonal Pop", "code_information": [ { "code": "81264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2084, "discounted_cash": 172, "minimum": 138.18, "maximum": 1667.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 138.18 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 190, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 241.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 162.57 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 365.44, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 346.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 346.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 296.57 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 181.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 207.28, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.28, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 195.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Urinalysis Nonauto W/O Scope", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31, "discounted_cash": 3, "minimum": 2.78, "maximum": 24.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 2.78 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.57 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 3", "code_information": [ { "code": "1143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7402.02, "maximum": 7846.1412, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7402.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7846.14, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7402.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7402.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7772.12, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 7.6-12.5 Cm", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372, "discounted_cash": 727, "minimum": 64.6908, "maximum": 372, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 372 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 372 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 372 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 372 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 372 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 372 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 372 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 372, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hiv-1", "code_information": [ { "code": "86701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88, "discounted_cash": 8, "minimum": 7.11, "maximum": 70.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.12 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 43.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 37.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "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": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Brca1 Brca2 Gene Analysis Full Dup/Del Analysis", "code_information": [ { "code": "81164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2921.15, "discounted_cash": 584, "minimum": 467.38, "maximum": 2336.92, "payers_information": [ { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 642.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 584.23, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 817.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 876.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 467.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 584.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1236.06, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 467.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 740.97 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 740.97 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 584.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 634.18 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 495.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 607.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 584.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 701.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 601.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 613.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 584.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 584.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 701.08, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 701.08, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 584.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 584.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 660.18, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 467.38 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 613.44, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40508, "minimum": 32233.839, "maximum": 79769.19, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 38221.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 44559.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61453.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 52660.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 57990.65 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36401.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 79769.19 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 40458.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 36401.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 52969.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 37857.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 36401.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 48609.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 41723.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 42533.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40508.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59802.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 36401.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 60294.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46458.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36401.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 40508.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Indwel Tunneled Pleural Cath W Cuff", "code_information": [ { "code": "32550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4365, "discounted_cash": 3522, "minimum": 759.0735, "maximum": 4365, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3874.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4365, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4365, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4365, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4365, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2817.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4226.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3627.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3698.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4365, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4365, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3522.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3980.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insrt/Rep Subq Defibrillator And Lead", "code_information": [ { "code": "33270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63240, "discounted_cash": 30879, "minimum": 1582, "maximum": 63240, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32423.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 33967.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63240, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 43231.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46319.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30879.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63240, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24703.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30879.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32114.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 30879.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37055.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31805.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 32423.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30879.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30879.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 63240, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49647.09, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30879.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 30879.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34893.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cyto/Molecular Report", "code_information": [ { "code": "88291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 840, "minimum": 22.7, "maximum": 672, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.7 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8761, "minimum": 3868.07, "maximum": 15714.79, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8349.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9637.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12106.48 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11389.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11424.35 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7952.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15714.79 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5942.35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7952.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 12465.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8270.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7952.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10513.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9023.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 9199.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8761.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9489.85 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7952.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 11878.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9152.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7952.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8761.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3868.07 } ] } ] }, { "description": "Hc Percut Remv Kid Stone,2+ Cm", "code_information": [ { "code": "50081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37263.3, "discounted_cash": 9312, "minimum": 776, "maximum": 29810.64, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9778.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10244.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22511.82, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13038, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13969.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9312.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20739.74, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7450.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9312.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 5089 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9685.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9312.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11175.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9592.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 9778.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9312.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9312.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19894.93, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14972.89, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9312.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9312.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10523.53, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15355, "minimum": 8227.1, "maximum": 29020.42, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14554.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16891.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22356.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19962.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21097.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13861.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29020.42 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12739.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13861.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21776.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14416.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 13861.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18426.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15816.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 16123.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15355.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8227.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13861.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 21935.37 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16901.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13861.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15355.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11080.1 } ] } ] }, { "description": "Hc Unlisted Dx Radiographic Procedure", "code_information": [ { "code": "76499", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51, "discounted_cash": 85, "minimum": 8.8689, "maximum": 51, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240, "discounted_cash": 14, "minimum": 11.568, "maximum": 192, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.59, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 67.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.07 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.35 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bamlanivimab And Etesevimab Infusion And Monitoring", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1548, "discounted_cash": 433, "minimum": 269.1972, "maximum": 1238.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 455.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 477.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1048.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 607.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 650.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 360 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.05, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 450 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 450 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 450 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 451.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 433.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 520.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 446.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 455.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 433.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 926.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 697.43, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 406.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 433.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 490.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8060, "minimum": 5779.2543, "maximum": 14638.77, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7690.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8866.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11018.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10479.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10397.23 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7324.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14301.94 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6159.82 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7324.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11839.47 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7617.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7324.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9673.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8302.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8463.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8060.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8141.64 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7324.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10810.26 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8329.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7324.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8060.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14638.77 } ] } ] }, { "description": "Hc Expose Femoral Art, Groin Incis Uni (Aaa Repr)", "code_information": [ { "code": "34812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1785, "minimum": 310.4115, "maximum": 1785, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1785 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1785 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1785 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1785 } ] } ] }, { "description": "Hc Microalbumin, Quantitative", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 5, "minimum": 4.62, "maximum": 73.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.62 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 28.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 24.08 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 41.1, "10th_percentile": 41.1, "90th_percentile": 41.1, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Destruct By Neuro Agent; Pudendal", "code_information": [ { "code": "64630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 870, "minimum": 555.5496, "maximum": 3194.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 957.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2103.33, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1218.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1305.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1937.76, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 896.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1858.83, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1398.95, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 983.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Radioulna Disloc W Manip", "code_information": [ { "code": "25675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 242, "minimum": 104, "maximum": 999.15, "payers_information": [ { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5556, "minimum": 3563.39, "maximum": 10350, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 5334.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 6112.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7125.31 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 7223.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 6723.84 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5080.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9249 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3563.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 5080.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 8658.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 5283.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 5080.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 6667.79, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 5723.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 5834.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5556.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4572.4 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 5080.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 6990.94 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 5386.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5080.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5556.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5929.28 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [ { "code": "082", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20232, "minimum": 14574.9, "maximum": 38859.38, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 19143.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 22255.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29936.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26301.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 28250.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38859.38 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 18237.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 18231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 27037.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 18961.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 18231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24278.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20839.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 21243.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20232.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19352.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 18231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 29372.25 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 22632.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20232.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14574.9 } ] } ] }, { "description": "Hc Assay Of Citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 541, "discounted_cash": 27, "minimum": 19.2, "maximum": 432.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.24 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.82, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 128.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 109.99 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.36 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Thyroid Uptake W/Blood Flow Sngle/Mult Quan", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2500, "discounted_cash": 393, "minimum": 159.96, "maximum": 2000, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 432.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 950.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 550.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 875.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 314.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 333.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 333.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 366.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.56 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 409.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 471.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 840.16, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 632.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 180.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 444.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [ { "code": "580", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15533, "minimum": 11871.792, "maximum": 29379.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14722.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17086.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22633.34 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20193.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21358.08 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29379.16 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16396.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20368.74 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14582.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 14021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18640.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15999.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 16310.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15533.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23697.4 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 22206.53 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17110.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15533.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methadone - 80358 - 30100205", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469.16, "minimum": 16.48, "maximum": 375.328, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.03 } ] } ] }, { "description": "Hc Acoustic Immitance Testing", "code_information": [ { "code": "92570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 126, "minimum": 23.45, "maximum": 519, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 305.98, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 177.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 189.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 281.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 101.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 132.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 270.41, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 203.51, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 126.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hla I&Li Low Resolution Hla-A -B&-Drb1", "code_information": [ { "code": "81371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1129.33, "discounted_cash": 404, "minimum": 262.69, "maximum": 903.464, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 323.62 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 444.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 566.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 606.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.69 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 855.84, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 558.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 478 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 485.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 416.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 424.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 485.42, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 485.42, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hetastarch (Hes /0.7 Or /0.75) 6% In Nacl 0.9% Iv Soln - 10019099959", "drug_information": { "unit": 500, "type": "ML" }, "code_information": [ { "code": "10019099959", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "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": 42445, "minimum": 11382.89, "maximum": 83677.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 40044.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 46690.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 64464.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 55179.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 60832.21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 83677.91 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 33557.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 38137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 56942.01 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 39663.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 38137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 50934.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 43718.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 44567.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42445.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42277.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 38137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 63248.77 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 48734.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 42445.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11382.89 } ] } ] }, { "description": "Hc Insert Ventr Pm W Transvenous Electrode", "code_information": [ { "code": "33207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15588, "discounted_cash": 10282, "minimum": 488.9, "maximum": 15588, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10796.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11310.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15588, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14395.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15423.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10282.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15588, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8225.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 4816.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4816.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10282.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3816.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10693.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 10282.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12338.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10590.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 10796.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10282.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10282.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15588, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15588, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10282.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10282.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11619.12, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES- SOI : 4", "code_information": [ { "code": "1434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15798.46, "maximum": 16746.3676, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15798.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16746.37, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15798.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15798.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16588.38, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay, Free Hydroxyproline", "code_information": [ { "code": "83500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.92, "discounted_cash": 22, "minimum": 10.776, "maximum": 35.92, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 24.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.65 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.92, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sigmoidoscopy,Biopsy", "code_information": [ { "code": "45331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069, "discounted_cash": 914, "minimum": 67.5, "maximum": 1069, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 960.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1006.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1069, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1069, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1069 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 731.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1069 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1069 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1069 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 951.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 914.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1069, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1069 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 942.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 960.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 914.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1069, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1069, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1069 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 914.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 914.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1033.8, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Barbiturates - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.95, "minimum": 10.185, "maximum": 27.16, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.05 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.46 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.08 } ] } ] }, { "description": "LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8194, "maximum": 8685.64, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8194, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8685.64, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8194, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8194, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8603.7, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Moderate Sedatj Diff Phys/Qhp Ea Addl 15 Min", "code_information": [ { "code": "99157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 424.22, "minimum": 46.31, "maximum": 339.376, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.31 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.33 } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 4", "code_information": [ { "code": "1784", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 57836.72, "maximum": 61306.9232, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 57836.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 61306.92, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 57836.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 57836.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 60728.56, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Tte Congenital Anom W Or Wo/W Cont, Complt - C8921 - 48300021", "code_information": [ { "code": "C8921", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651, "discounted_cash": 771, "minimum": 461.0089, "maximum": 2120.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 848.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.18, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1079.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1156.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1717.44, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 616.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1040.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1040.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1029.98 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 802.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 925.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 794.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 809.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1647.48, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1239.89, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 771.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 871.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Prox Tib/Fib Disloc Wo Anes", "code_information": [ { "code": "27830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 242, "minimum": 112, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us,Transrectal", "code_information": [ { "code": "76872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 894.25, "discounted_cash": 102, "minimum": 54.15, "maximum": 715.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.15 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 236.08 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 236.08 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 259.58 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Digital Breast Tomosynthesis Bilat - 77062 - 40100011", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.2, "minimum": 22.51, "maximum": 394.56, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 167.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 184.65 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 147.96, "10th_percentile": 147.96, "90th_percentile": 147.96, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.44 } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [ { "code": "327", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21568, "minimum": 7951.95, "maximum": 41555.87, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 20400.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 23725.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32014.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28039.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 30210.31 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19429.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41555.87 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 21162.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 19429.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 30855.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 20206.58, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 19429.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25882.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22215.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 22647.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21568.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27241 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 19429.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 31410.41 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 24202.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19429.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21568.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7951.95 } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm Ea Ad 100Sqcm", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4567, "minimum": 794.2013, "maximum": 3653.6, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "Hc Egd Flex Intraluminal Tube/Catheter Insertion", "code_information": [ { "code": "43241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8294.05, "discounted_cash": 1887, "minimum": 143.1, "maximum": 6635.24, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2076.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4563.25, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2642.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4204.04, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1510.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1963.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2265.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1944.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4032.8, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3035.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2133.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12763, "minimum": 6750, "maximum": 23790.66, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12115.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14040.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18328.03 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16592.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 17295.35 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11539, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23790.66 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13724.66 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11539, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 19095.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12000.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 11539, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15316.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13146.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 13401.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12763.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17613.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11539, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 17982.4 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13855.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11539, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12763.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hemoglobin", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46, "discounted_cash": 2, "minimum": 1.896, "maximum": 36.8, "payers_information": [ { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.01, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.84 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 1.9 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.23 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablation 1/> Liver Tumor Perq Cryoablation", "code_information": [ { "code": "47383", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12269, "discounted_cash": 10457, "minimum": 776, "maximum": 12269, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10980.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11503.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12269, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12269, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12269, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12269, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8365.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10875.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 10457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12269, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10771.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 10980.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12269, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12269, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11816.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Thermoplasty =>2 Lobes", "code_information": [ { "code": "31661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15451.8, "discounted_cash": 6942, "minimum": 1582, "maximum": 15451.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7290.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7637.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9720.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10414.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5554.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7220.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8331.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7290.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14832.11, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11162.62, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7845.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8175, "minimum": 3203.02, "maximum": 14533.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7798.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8993.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11196.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10628.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10565.33 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14533.16 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7847.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11757.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7724.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7427.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9810.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8420.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8584.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8175.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8528.36 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7427.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10985.03 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8464.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8175.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3203.02 } ] } ] }, { "description": "Hc Heterophile Antibodies,Titer+", "code_information": [ { "code": "86310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.03, "discounted_cash": 7, "minimum": 3.009, "maximum": 10.03, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 541, "discounted_cash": 11, "minimum": 9.288, "maximum": 432.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 56.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 48.71 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.93 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22089.4, "discounted_cash": 5474, "minimum": 22.5, "maximum": 17671.52, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11694.44, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8801.21, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6185.83, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5747.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6021.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13232.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7663.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8211.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12191.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4379.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5693.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6569.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5638.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5747.9, "additional_payer_notes": "105.00% 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": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Radn Physics Consult Continuing", "code_information": [ { "code": "77336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 587.95, "discounted_cash": 132, "minimum": 48.6759, "maximum": 470.36, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 145.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.61, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 185.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 198.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 294.45, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.68 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 48.68 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 51.22 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 158.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 136.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 138.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 282.46, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.58, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 149.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh Phenotype", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.17, "discounted_cash": 36, "minimum": 6.2, "maximum": 128.936, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.81, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.82, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 34.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 29.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.49, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Moder Sedate Same Phys/Qhp 5/>Yrs Init 15 Min", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350, "minimum": 9.9, "maximum": 280, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.19 } ] } ] }, { "description": "Hc Ercp Destruction/Lithotripsy Calculi Any Method", "code_information": [ { "code": "43265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5174, "discounted_cash": 5972, "minimum": 776, "maximum": 5174, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4777.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5174, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Percut Biopsy, Abdominal Mass", "code_information": [ { "code": "49180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1784, "discounted_cash": 1624, "minimum": 310.2376, "maximum": 1784, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1784, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1784, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1784, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1784, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1784, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1784 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1784 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1784 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1784 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1784, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1784, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1784, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1784 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1784, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nicotine - 80323 - 30100416", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180, "minimum": 17.62, "maximum": 144, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.62 } ] } ] }, { "description": "Hc Removal Foot Fb Subq", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1145, "discounted_cash": 696, "minimum": 199.1155, "maximum": 5474.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 766.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 975.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1145 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 557.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1145 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 724.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 835.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 717.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 777 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1145, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1120.03, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1145 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 787.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [ { "code": "866", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8300, "minimum": 5579.65, "maximum": 14784.79, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7916.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9130.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11390.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10790.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10748.26 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7539.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14784.79 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5579.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7539.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11348.23 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7840.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7539.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9960.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8549.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8715.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8300.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6267.81 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7539.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 11175.23 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8610.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7539.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8300.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Intercostal, Single", "code_information": [ { "code": "64420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.95, "discounted_cash": 694, "minimum": 43.5, "maximum": 2040, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 763.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1678.61, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 972.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1041.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 555.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 722.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 833.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 715.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 729.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1483.48, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1116.46, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Flumazenil Iv Soln 0.5 Mg/5Ml (0.1 Mg/Ml) - 55390009210", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "55390009210", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "Hc Heparin Neutralization", "code_information": [ { "code": "85525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11, "minimum": 9.47, "maximum": 111.144, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.05, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 66.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY TRANSPLANT", "code_information": [ { "code": "652", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28186, "minimum": 19350, "maximum": 54907.41, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 26627.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 31004.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42299.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 36641.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 39916.62 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25359.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54907.41 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 30448.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 25359.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 40590.43 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 26373.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 25359.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33823.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 29031.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 29595.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28186.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40440 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 25359.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 41502.3 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 31978.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25359.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28186.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7842.15, "discounted_cash": 727, "minimum": 581.664, "maximum": 6273.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 763.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 799.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1757.56, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1017.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1090.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1619.21, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 581.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 872.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 748.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 763.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1553.25, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1168.97, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 821.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Forearm Soft Tissues,Superfic", "code_information": [ { "code": "25065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1624, "minimum": 776, "maximum": 4946.48, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3927.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2274.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2437.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3618.43, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3471.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2612.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate Kinase", "code_information": [ { "code": "84220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195, "discounted_cash": 9, "minimum": 7.55, "maximum": 156, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.55 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.97, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 39.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MALFUNCTION,REACTION,COMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE - SOI : 4", "code_information": [ { "code": "2064", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17835.85, "maximum": 18906.001, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17835.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18906, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17835.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17835.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18727.64, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Selenium", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250, "discounted_cash": 25, "minimum": 17.6, "maximum": 200, "payers_information": [ { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 28.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.53 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.01, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 118.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 30.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.85, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.42 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Massage Therapy Ea 15 Min", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214, "discounted_cash": 30, "minimum": 16.75, "maximum": 180, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 33.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 65.02, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 80.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.8, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.16, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.72, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Lyme Disease Antibody, Confirmatory", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325, "discounted_cash": 15, "minimum": 12.39, "maximum": 260, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 66.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 57.27 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Destruct Internal Hemorrhoid, Thermal", "code_information": [ { "code": "46930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3338.35, "discounted_cash": 1177, "minimum": 580.5391, "maximum": 3338.35, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1294.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2845.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1648.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1765.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.67, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 941.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3338.35 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1412.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1212.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2514.88, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1892.69, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1330.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Cath In Artery, R Heart Or Main Pulm Art", "code_information": [ { "code": "36013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 862, "minimum": 121.4, "maximum": 862, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 862 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 862 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 862 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 862 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 862 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 862 } ] } ] }, { "description": "Hc Inj Nerv Blck, Sciatic, Continu W Cath", "code_information": [ { "code": "64446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 870, "minimum": 82.36, "maximum": 2555.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 957.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2103.33, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1218.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1305.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1937.76, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 896.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1858.83, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1398.95, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 983.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Glucose Tolerance Test (Gtt)", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 222, "discounted_cash": 12, "minimum": 10.296, "maximum": 177.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 53.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [ { "code": "125", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7442, "minimum": 5274.978, "maximum": 13054.01, "payers_information": [ { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8186.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10056.64 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9675.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9490.01 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6770.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13054.01 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5432.08 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6770.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11228.64 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7041.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6770.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8930.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7665.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7814.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7442.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8167.27 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6770.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9867 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7602.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6770.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7442.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9305.17 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7108.87, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SMALL BOWEL PROCEDURES - SOI : 1", "code_information": [ { "code": "2301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9310.15, "maximum": 9868.759, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9310.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9868.76, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9310.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9310.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9775.66, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Pap By Tech, Screening", "code_information": [ { "code": "P3000", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83, "discounted_cash": 18, "minimum": 8.88, "maximum": 66.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.88 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.23, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 20.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tobacco Cessation Asymptomatic 3-10 Min", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.5, "discounted_cash": 36, "minimum": 16.6075, "maximum": 94, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 89.1, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 82.09, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 90 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 40.82, "10th_percentile": 40.82, "90th_percentile": 40.82, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 36.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 38.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.74, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.26, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES- SOI : 2", "code_information": [ { "code": "0302", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20760.27, "maximum": 22005.8862, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20760.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 22005.89, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 20760.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20760.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21798.28, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 1", "code_information": [ { "code": "3241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10264.21, "maximum": 10880.0626, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10264.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10880.06, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10264.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10264.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10777.42, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Lumbar Plex Post, Continu W Cath", "code_information": [ { "code": "64449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 870, "minimum": 555.5496, "maximum": 2555.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 957.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2103.33, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1218.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1305.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1937.76, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 896.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1858.83, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1398.95, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 870.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 983.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15713, "minimum": 12018.1283, "maximum": 29741.3, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14891.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17284.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22912.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20426.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21621.35 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29741.3 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14805.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 22588.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14749.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 14182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18855.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16184.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 16498.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15713.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19534.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 22480.25 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17321.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14182, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15713.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Talus Fx W Manip", "code_information": [ { "code": "28435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1581, "minimum": 145, "maximum": 4869.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1740.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3823.9, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2214.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3522.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1265.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1645.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1629.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3379.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1787.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH CC", "code_information": [ { "code": "571", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15209, "minimum": 10451.74, "maximum": 28724.59, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22129.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19771.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20882.22 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13730.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28724.59 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10451.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13730.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21694.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14279.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 13730.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18250.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15665.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 15969.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15209.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19080.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13730.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 21711.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16729.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13730.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15209.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14416.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16730.07, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sclerotherapy Fluid Collection Prq W/ Img Gdn", "code_information": [ { "code": "49185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6363, "discounted_cash": 1624, "minimum": 1090.5, "maximum": 5090.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3927.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2274.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2437.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3618.43, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3471.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2612.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH MCC", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17280, "minimum": 13295.9948, "maximum": 32903.64, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 16365.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 19008.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25348.56 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22464.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 23920.31 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15586.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32903.64 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 18018.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 15586.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21756.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 16209.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 15586.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20736.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17798.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 18144.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17280.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24384.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 15586.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 24870.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 19163.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15586.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17280.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [ { "code": "273", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35736, "minimum": 6979.7, "maximum": 70141.05, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 33731.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 39309.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54035.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 46457.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 50991.18 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70141.05 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 36143.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 32125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 44552 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 33410.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 32125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 42883.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 36808.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 37523.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35736.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53451.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 32125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 53016.8 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 40850.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32125.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 35736.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6979.7 } ] } ] }, { "description": "Rpr aa hrn 1st 3-10 ncrstrn", "code_information": [ { "code": "49594", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6402, "discounted_cash": 5947, "minimum": 776, "maximum": 6402, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6244.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6402, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6402, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6402, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6402, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6402, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4757.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6185.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6402, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6125.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6244.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6402, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6402, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5947.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6402, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14048, "minimum": 7650, "maximum": 26383.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13325.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15453.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20325.48 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18263.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 19180.25 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12690.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26383.44 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15192.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12690.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20094.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13198.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12690.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16858.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14470.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14751.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14048.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21972.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12690.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19942.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15365.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12690.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14048.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Compatibility Test, Electronic", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 686.55, "discounted_cash": 167, "minimum": 12, "maximum": 549.24, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 184.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 405.14, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 234.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 373.25, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 134.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 53.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 358.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.46, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 189.39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nasal Endo Dx W/Maxillary Sinusoscopy", "code_information": [ { "code": "31233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6348.95, "discounted_cash": 384, "minimum": 307.816, "maximum": 5079.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 423.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 930.1, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 538.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 577.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 384.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 856.88, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 307.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 384.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 384.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 461.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 396.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 404.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 384.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 384.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 821.98, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 618.62, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 384.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 384.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 434.79, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venous Cutdown <1 Y/O", "code_information": [ { "code": "36420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.7, "discounted_cash": 130, "minimum": 44.75, "maximum": 279.7, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 279.7, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.75 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 279.7, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 279.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Biovlbl Testosterone Direct Measurement", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.6, "discounted_cash": 51, "minimum": 41.02, "maximum": 253.28, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.02 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 56.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 108.49, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 105.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 53.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 61.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell C1874) Stent Coated/Covr W/Delivery System", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 500, "10th_percentile": 500, "90th_percentile": 500, "count": "1 through 10" } ] } ] }, { "description": "Hc Clsd Treat Dist Fingr Fx Wo Manip Ea", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333, "discounted_cash": 242, "minimum": 48, "maximum": 333, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 333, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 333, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 333, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 333, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 333 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 333 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 333 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 333, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 333, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 333 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img", "code_information": [ { "code": "64451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3294.5, "discounted_cash": 694, "minimum": 454.38, "maximum": 3294.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 763.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1678.61, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 972.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1041.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 555.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3294.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 722.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 833.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 715.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 729.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1483.48, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1116.46, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Ketamine Hcl Inj 10 Mg/Ml - 42023011310", "drug_information": { "unit": 20, "type": "ML" }, "code_information": [ { "code": "42023011310", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "Hc Esophagoscopy Flex W Us Exam", "code_information": [ { "code": "43231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 1887, "minimum": 174.2, "maximum": 3575.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2076.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2642.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1510.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1963.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2265.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1944.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3035.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2133.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Unilat Select", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8060, "discounted_cash": 3106, "minimum": 22.5, "maximum": 7508.6611, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6917.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% 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": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7508.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 } ] } ] }, { "description": "Hc I&D Below Fascia Foot, Multiple", "code_information": [ { "code": "28003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 3218, "minimum": 776, "maximum": 9753.36, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3540.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7781.02, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4506.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4828.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7168.51, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2575.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3862.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3315.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6876.51, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5175.25, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3637.37, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE DT MUSCSKEL MALIG - SOI : 1", "code_information": [ { "code": "3431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7039.55, "maximum": 7461.923, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7039.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7461.92, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7039.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7039.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7391.53, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mra Spinal Canal Wo/W Contrast - 72159 - 61800012", "code_information": [ { "code": "72159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3174, "minimum": 377.3, "maximum": 2539.2, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 399.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 426.35 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9236, "minimum": 6737.6542, "maximum": 16673.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8796.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10160.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12845.21 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12007.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12121.45 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16673.69 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6837.09 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13340.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8713.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8378.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11083.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9513.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 9698.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9236.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9343.49 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8378.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 12602.98 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9710.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9236.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7764.77 } ] } ] }, { "description": "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES - SOI : 4", "code_information": [ { "code": "3174", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26968.18, "maximum": 28586.2708, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 26968.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 28586.27, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 26968.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26968.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28316.59, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cytomeg Dna Quant", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 850, "discounted_cash": 42, "minimum": 34.27, "maximum": 680, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.27 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.54 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.64, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 185.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 158.43 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 51.41 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6976, "minimum": 4351.72, "maximum": 12113.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6670.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7674.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9332.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9069.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8806.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6352.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12113.8 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4351.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6352.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9363.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6606.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6352.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8371.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7185.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7325.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6976.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7102.17 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6352.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9156.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7055.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6352.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6976.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7966.26 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17663, "minimum": 7878.18, "maximum": 33677.22, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 16726.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 19430.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25944.52 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22962.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 24482.69 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15930.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33677.22 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 17943.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 15930.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 22888.24 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 16567.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 15930.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21196.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18193.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 18547.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17663.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30208.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 15930.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 25455.26 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 19613.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15930.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17663.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7878.18 } ] } ] }, { "description": "Hc Perc D-E Cor Revasc Chro Sin", "code_information": [ { "code": "C9607", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85888, "discounted_cash": 18034, "minimum": 1582, "maximum": 68710.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18935.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19837.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43593.77, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25247.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27051.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40162.16, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14427.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18755.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21641.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18575.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18935.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38526.21, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28994.76, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20378.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12978, "minimum": 9196.63, "maximum": 24224.21, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12318.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14276.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18662.03 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16872.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 17610.53 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24224.21 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9196.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 18238.47 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12200.86, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 11731.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15574.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13368, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 13627.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12978.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13902 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11731.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 18310.1 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14108.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12978.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7627, "minimum": 4635.98, "maximum": 14283.12, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7283.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8390.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10344.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9916.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9761.93 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6936.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13428.05 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4635.98 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6936.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11615.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7213.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6936.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9153.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7856.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8009.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6169.53 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6936.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10149.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7820.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6936.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7627.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14283.12 } ] } ] }, { "description": "Hc Leukocyte Count,Fecal", "code_information": [ { "code": "89055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119, "discounted_cash": 4, "minimum": 3.416, "maximum": 95.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.42 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.77 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 16.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Dx/Ther Sbst Intrlmnr Crv/Thrc Wo Img", "code_information": [ { "code": "62320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1969.34, "discounted_cash": 694, "minimum": 342.4682, "maximum": 1969.34, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 763.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1678.61, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 972.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1041.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 555.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1969.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 722.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 833.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 715.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 729.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1483.48, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1116.46, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1969.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 694.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "URINARY STONES WITHOUT MCC", "code_information": [ { "code": "694", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7559, "minimum": 4245.31, "maximum": 13290.33, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7219.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8315.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10238.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9827.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9661.81 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6875.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13290.33 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4245.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6875.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9961.27 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6875.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9071.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7786.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7937.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7559.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6204.78 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6875.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10045.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7740.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6875.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7559.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Trlml Blln Angiop Open/Perq W/Img S&I Addl Vein", "code_information": [ { "code": "37249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22696.1, "minimum": 130.5, "maximum": 18156.88, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "Hc Revasc Lithotr-Stent Tib/Per", "code_information": [ { "code": "C9773", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1832.1, "discounted_cash": 18034, "minimum": 318.6022, "maximum": 1832.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1832.1 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1832.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1832.1, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Oncoprotein Dcp", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 879, "discounted_cash": 64, "minimum": 51.528, "maximum": 703.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.53 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 70.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.81 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 136.27, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 91.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 78.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 77.29 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.78, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tympanometry", "code_information": [ { "code": "92567", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 36, "minimum": 12, "maximum": 122.04, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.81, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.82, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.49, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prostate Specific Antigen,Free", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351, "discounted_cash": 18, "minimum": 14.71, "maximum": 280.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.91, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 79.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 67.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.07 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.78, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36914, "minimum": 3982.8, "maximum": 72517.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 34840.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 40605.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55866.9 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 47988.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 52719.11 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33181.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 72517.91 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3982.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 33181.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 34508.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 33181.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 44297.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 38021.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 38760.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36914.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5569.13 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 33181.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 54813.37 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 42235 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33181.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 36914.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6890.51 } ] } ] }, { "description": "Hc Assay Of Estriol", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 543, "discounted_cash": 24, "minimum": 17.5, "maximum": 434.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.34 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.16, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 115.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 98.48 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 29.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213, "discounted_cash": 11, "minimum": 8.928, "maximum": 170.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.61, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 49.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 42.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8486.03, "maximum": 8995.1918, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8486.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8995.19, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8486.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8486.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8910.33, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "TESTES PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "712", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10239, "minimum": 7555.2139, "maximum": 18696.91, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12286.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10546.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 10751.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10239.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11118 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9276.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 14132.24 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10889.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9276.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10239.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9740.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11263.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14403.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13310.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 13592.29 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9276.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18696.91 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7836.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9276.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14354.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9647.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 9276.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remv Transven Pacer Electrode,2 Lead", "code_information": [ { "code": "33235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12798, "discounted_cash": 3676, "minimum": 1090.5, "maximum": 10238.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3860.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4043.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8886.71, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5146.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5514.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8187.16, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2941.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3823.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4411.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3786.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3860.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7853.67, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5910.66, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3676.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4154.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS & INJURIES - SOI : 3", "code_information": [ { "code": "0403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15513.95, "maximum": 16444.787, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15513.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16444.79, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15513.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15513.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16289.65, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Infectious Agent Genotype Hepatitis B Virus", "code_information": [ { "code": "87912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 885, "discounted_cash": 257, "minimum": 205.96, "maximum": 708, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 205.96 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 283.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 257.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 360.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.1 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 544.69, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 468.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 468.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 308.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 265.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 270.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.94 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 308.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 290.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Calprotectin Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.48, "discounted_cash": 19, "minimum": 15.7, "maximum": 64.384, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.7 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.94 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.53, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 27.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 23.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23.56 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Range Of Motion Measurements - 95852 - 42000050", "code_information": [ { "code": "95852", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287, "discounted_cash": 5, "minimum": 4.144, "maximum": 229.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Imag,Acute Venous Thrmbsis,Unilat", "code_information": [ { "code": "78457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6833.64, "discounted_cash": 534, "minimum": 65, "maximum": 5466.912, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 587.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1291.22, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 747.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 801.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1189.57, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 427.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 350.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 350.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 385.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 640.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 550.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 560.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1141.12, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 858.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 603.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 56379, "minimum": 23400, "maximum": 111792.13, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 53156.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 62017.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 86123.28 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 73293.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 81270.71 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 111792.13 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 77503.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 50624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 76327.78 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 52649.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 50624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 67655.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 58071.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 59198.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56379.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56109 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 50624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 84499.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 65108.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 50624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 56379.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33124.68 } ] } ] }, { "description": "Hc Remove Foreign Body Complex", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 947, "discounted_cash": 1624, "minimum": 164.6833, "maximum": 7682.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 947 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 947 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 947 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 947 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 947 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 720 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 947 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 947, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT", "code_information": [ { "code": "469", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26531, "minimum": 15750, "maximum": 51569.95, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 25071.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 29185.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39728.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 34491.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 37490.35 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51569.95 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 25652.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 23877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 38944.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 24832.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 23877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31838.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 27327.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 27858.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26531.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36339.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 23877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 38979.65 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30034.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 26531.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nasal Endo Sx,Maxillary Antrostomy & Tissue Remv", "code_information": [ { "code": "31267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21814.8, "discounted_cash": 6942, "minimum": 776, "maximum": 17451.84, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7290.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7637.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16783.05, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9720.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10414.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15461.93, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5554.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 5089 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7220.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8331.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7290.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14832.11, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11162.62, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6942.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7845.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office Outpatient New 10 Min", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185, "discounted_cash": 130, "minimum": 32.1715, "maximum": 999.304, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 144.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 185, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 185, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC", "code_information": [ { "code": "802", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34544, "minimum": 27371.763, "maximum": 67736.99, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 32610.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 37999.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52183.74 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 44908.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 49243.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31057.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 67736.99 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 43220.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 31057.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 40972.64 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 32300.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 31057.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 41453.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 35581.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 36272.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34544.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42509.4 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 31057.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 51199.67 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 39450.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31057.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 34544.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Vit D, 1,25-Dihydroxy W Fractions", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572, "discounted_cash": 38, "minimum": 30.8, "maximum": 457.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.8 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 42.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.78 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.45, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 185.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 158.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 46.2 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.51, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13614, "minimum": 7794.5, "maximum": 25507.85, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18330.2 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12301.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19280.36 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14855.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13614.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7794.5 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12916.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14976.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19650.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17699.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18543.71 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25507.85 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13810.09 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12301.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 19232.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12793.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12301.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16337.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14023.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14295.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13614.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clot Factor Wght Kininogen", "code_information": [ { "code": "85293", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.93, "discounted_cash": 18, "minimum": 15.14, "maximum": 185.544, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.05, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 92.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 78.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10505, "minimum": 7772.3138, "maximum": 19234.17, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9991.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11555.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14817.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13657.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 13982.87 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19234.17 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8334.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 15356.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9895.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 9515.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12606.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10820.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 11030.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10505.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9895.81 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9515.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 14538.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 11202.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10505.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Elastase Pancreatic Fecal Quantitative", "code_information": [ { "code": "82653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 825, "discounted_cash": 22, "minimum": 18.376, "maximum": 660, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 48.6, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 35.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 30.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 24.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Stent Ather Br - C9603 - 48100195", "code_information": [ { "code": "C9603", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10388, "minimum": 1582, "maximum": 8310.4, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES- SOI : 1", "code_information": [ { "code": "1761", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13354.83, "maximum": 14156.1198, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13354.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 14156.12, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 13354.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13354.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14022.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Calcium Chloride Inj 10% - 00548330400", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00548330400", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4916.67, "maximum": 5211.6702, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4916.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5211.67, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4916.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4916.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5162.5, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Iron Binding Test", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159, "discounted_cash": 8, "minimum": 5, "maximum": 127.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.99 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.49, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 42.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 36.39 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.49 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.88, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Pm Pulse Gen Only (Existing Leads)", "code_information": [ { "code": "33221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83834.3, "discounted_cash": 18949, "minimum": 776, "maximum": 67067.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19896.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20844.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 45805.48, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26528.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28423.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18949.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42199.78, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15159.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18949.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19707.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18949.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22738.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19517.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 19896.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18949.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18949.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40480.83, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30465.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18949.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18949.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21412.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient Established Minimal Problem(S) - G0463 - 76100006", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1249.13, "discounted_cash": 130, "minimum": 32.1715, "maximum": 999.304, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 144.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.62, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.69, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.81, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.59, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15837, "minimum": 8733.73, "maximum": 29992.93, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15008.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17421.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23106.18 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20589.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21804.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29992.93 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8733.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 22631.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14865.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19005.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16312.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 16629.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15837.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8933.26 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 22670.45 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17468.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15837.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25988.63 } ] } ] }, { "description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [ { "code": "792", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21610, "minimum": 1599.18, "maximum": 41640.88, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 20440.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 23771.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32079.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28094.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 30272.11 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19467.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41640.88 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 1599.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 19467.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 28235.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 20245.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 19467.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25933, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22259.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 22691.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21610.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2420.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 19467.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 31474.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19467.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21610.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Skin Malig >4 Cm Trnk/Arm/Leg", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1624, "minimum": 776, "maximum": 4946.48, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3927.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2274.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2437.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3618.43, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3471.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2612.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rbc Sed Rate, Auto", "code_information": [ { "code": "85652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106, "discounted_cash": 2, "minimum": 2.16, "maximum": 84.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 2.16 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12812.6, "discounted_cash": 3106, "minimum": 22.5, "maximum": 10250.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7508.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6917.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% 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": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Dioxide", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69, "discounted_cash": 4, "minimum": 3.9, "maximum": 55.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Echo Tthrc R-T 2D W/Wo M-Mode Rst&Strs Cont Ecg", "code_information": [ { "code": "93351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2217.53, "discounted_cash": 537, "minimum": 119.21, "maximum": 2723.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 564.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 591.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1299.39, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 752.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 806.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 537.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1197.1, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 430.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 975.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 975.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 537.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 965.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 559.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 537.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 645.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 553.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 564.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 537.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 537.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1148.34, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 864.24, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 537.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 537.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 607.42, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I & Class Ii Antigens Qual", "code_information": [ { "code": "86828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1050, "discounted_cash": 64, "minimum": 43.52, "maximum": 840, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.35 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 89.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 135.81, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 91.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 78.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 77.03 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.53, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exhaled Air Analysis", "code_information": [ { "code": "94690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 58, "minimum": 4.5, "maximum": 140.2749, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 54.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 53.95 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.77 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 4", "code_information": [ { "code": "7924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36614.81, "maximum": 38811.6986, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 36614.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 38811.7, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 36614.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36614.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 38445.55, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY - SOI : 4", "code_information": [ { "code": "1604", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 103427.93, "maximum": 109633.6058, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 103427.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 109633.61, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 103427.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 103427.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 108599.33, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Explore Wound,Chest", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7138.85, "discounted_cash": 2029, "minimum": 1241.446, "maximum": 5711.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2131.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2232.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4906.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2841.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3044.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4520.36, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1623.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2110.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2435.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2090.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2131.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4336.23, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3263.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2029.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2293.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strapping Of Chest", "code_information": [ { "code": "29200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625.75, "discounted_cash": 159, "minimum": 34.83, "maximum": 625.75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 175.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 386.43, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 223.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 239.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.83 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 356.01, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 354.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 354.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 350.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 164.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 167.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.51, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 257.02, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 159.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 180.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nutr Ther, Subsq W Dx Change, Indiv, Ea 15 Min - 97803 - 94200011", "code_information": [ { "code": "97803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84, "discounted_cash": 22, "minimum": 14.6076, "maximum": 84, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 24.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 47.92, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 84 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS - SOI : 2", "code_information": [ { "code": "6512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13845.88, "maximum": 14676.6328, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14538.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 14676.63, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 13845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13845.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Sweat Sodium", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45, "discounted_cash": 4, "minimum": 3.888, "maximum": 36, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.89 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.86 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.43 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Translum Peripheral Atherectomy Renal Art", "code_information": [ { "code": "0234T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11638, "discounted_cash": 11356, "minimum": 1582, "maximum": 11638, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9085.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11356.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11638, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES - SOI : 3", "code_information": [ { "code": "4473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18679.8, "maximum": 19800.588, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18679.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 19800.59, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 18679.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18679.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19613.79, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS - SOI : 4", "code_information": [ { "code": "6514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36236.61, "maximum": 38410.8066, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 36236.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 38410.81, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 36236.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36236.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 38048.44, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14645, "minimum": 4409.8, "maximum": 27587.17, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13886.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16109.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21252.81 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19039.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20055.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13225.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27587.17 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14762.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13225.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21328.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13754.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 13225.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17574.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15084.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 15377.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14645.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21405.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13225.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 20852.03 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16066.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13225.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14645.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4409.8 } ] } ] }, { "description": "Hc Cytopath,Othr Sourc,Prep,Scrn,Interp", "code_information": [ { "code": "88161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.68, "discounted_cash": 28, "minimum": 8.8, "maximum": 95.744, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.34 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 31.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.77, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.36, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 67.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 57.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.33 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 60.78, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.74, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venogram Epidural", "code_information": [ { "code": "75872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 617, "minimum": 22.5, "maximum": 3831.128, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 647.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 678.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1491.75, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 863.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 925.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1374.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 493.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 740.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 635.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 647.98, "additional_payer_notes": "105.00% 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": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1318.34, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 992.18, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 617.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.35, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Surg Path,Level V", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1444.84, "discounted_cash": 352, "minimum": 11.5, "maximum": 1155.872, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 235.21 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 387.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 852.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 493.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 528.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 785.28, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 325.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 325.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 278.31 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 423.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 363.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 370.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 753.3, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 566.93, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.46, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Skin Sub Graft Trnk/Arm/Leg", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843, "discounted_cash": 727, "minimum": 581.664, "maximum": 6273.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 763.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 799.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1757.56, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1017.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1090.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1619.21, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 581.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 872.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 748.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 763.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1553.25, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1168.97, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 821.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7817.1, "discounted_cash": 1921, "minimum": 776, "maximum": 6253.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2113.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4643.7, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2689.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2881.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1921.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4278.16, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1536.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1921.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1997.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1921.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2305.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1978.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2017.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1921.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1921.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4103.89, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3088.58, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1921.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1921.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2170.78, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Brucella, Antibody", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155, "discounted_cash": 8, "minimum": 7.14, "maximum": 124, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.14 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.71 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.89, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.77 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 33.77 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 28.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Specimen Concentrat, Infect Agents", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208, "discounted_cash": 6, "minimum": 5.34, "maximum": 166.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.34 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 32.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 27.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Indigotindisulfonate Sodium Inj 8 Mg/Ml", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "00517037510", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "Hc Laryngoscopy Indirect Diagnostic", "code_information": [ { "code": "31505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207, "discounted_cash": 196, "minimum": 35.9973, "maximum": 207, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 207 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 207 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 207 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 207 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 207 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 206.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 207 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Toxin Or Antitoxin", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322, "discounted_cash": 19, "minimum": 15.79, "maximum": 257.6, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.31, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 21.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Flowcytometry/ Tech Component, 1 Marker", "code_information": [ { "code": "88184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 723.79, "discounted_cash": 352, "minimum": 37.14, "maximum": 723.79, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.38 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 387.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 723.79, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 493.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 528.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.14 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 723.79, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 226.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 226.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 193.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 423.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 363.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 370.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 723.79, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 566.93, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 352.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.46, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR LARGE BOWEL PROCEDURES - SOI : 1", "code_information": [ { "code": "2311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11357.11, "maximum": 12038.5366, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11357.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12038.54, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11357.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11357.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11924.97, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mgmt Methylation Analysis", "code_information": [ { "code": "81287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 486.33, "discounted_cash": 124, "minimum": 83.01, "maximum": 389.064, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 99.71 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 137.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 174.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 186.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.01 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 263.7, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 99.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.97 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 110.97 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 94.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 149.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 128.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 130.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 149.57, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 149.57, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.84, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "URETHRAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "671", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16098, "minimum": 12332.0987, "maximum": 30518.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15253.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17707.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23510.91 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20927.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 22186.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14527.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30518.28 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14758.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14527.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21467.29 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15108.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 14527.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19317.79, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16581.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 16903.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16098.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20440.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14527.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 23067.55 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17774.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14527.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16098.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Repair of tibia", "code_information": [ { "code": "27720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2967.13, "discounted_cash": 7138, "minimum": 515.9839, "maximum": 2967.13, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2967.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2967.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2967.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2967.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2967.13 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2967.13, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mammogram, Screening", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1100, "discounted_cash": 94, "minimum": 75.02, "maximum": 880, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 104.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 94.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 132.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200.93, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 146.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 160.57 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 330, "10th_percentile": 330, "90th_percentile": 330, "count": "50" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 94.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 99.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 113.96, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.96, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 94.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.32, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cytopath Tbs C/V Redo", "code_information": [ { "code": "88165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.18, "discounted_cash": 42, "minimum": 5.72, "maximum": 126.544, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.78 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 89.32, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 20.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 44.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 50.66 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.71, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS - SOI : 1", "code_information": [ { "code": "1301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21403.15, "maximum": 22687.339, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 21403.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 22687.34, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 21403.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21403.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22473.31, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Irrigat Corpus Cavern,Priapism", "code_information": [ { "code": "54220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2381, "discounted_cash": 245, "minimum": 196.632, "maximum": 2381, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 270.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 594.14, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 344.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 368.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 547.37, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2381 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 258.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 525.08, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 395.17, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 245.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 277.74, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Withdrawal Of Arterial Blood", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 130, "minimum": 13, "maximum": 513.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.49, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 27.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 26.98 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7192, "minimum": 2993.31, "maximum": 12550.75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6874.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7912.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9668.94 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9350.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9124.15 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12550.75 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 2993.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10075 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6808.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6546.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8631.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7408.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7552.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7192.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5094.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6546.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9486.61 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7309.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7192.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12278.07 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11686, "minimum": 8735.5229, "maximum": 21617.83, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11102.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12855.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16654.11 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15192.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 15715.74 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10574, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21617.83 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10653.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10574, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16390.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10996.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 10574, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14024.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12037.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 12271.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11686.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12993.9 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10574, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 16340.05 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 12590.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10574, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11686.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17032.5 } ] } ] }, { "description": "HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION - SOI : 2", "code_information": [ { "code": "8102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5735.32, "maximum": 6079.4392, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5735.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6079.44, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5735.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5735.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6022.09, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mri, Dorsal Spine", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3293, "discounted_cash": 234, "minimum": 187.2, "maximum": 2634.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 258.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 567.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 328.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1271.15 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 987.9, "10th_percentile": 987.9, "90th_percentile": 987.9, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.43 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 501.43, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 211.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Extrem Venous,Bilat", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1650, "discounted_cash": 234, "minimum": 114.2, "maximum": 1320, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 258.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 567.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 328.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1202.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1202.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1190.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.05 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 501.43, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "KNEE & LOWER LEG PROCEDURES EXCEPT FOOT - SOI : 4", "code_information": [ { "code": "3134", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30274.91, "maximum": 32091.4046, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 30274.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 32091.4, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 30274.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30274.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31788.66, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Nm Liver Imaging", "code_information": [ { "code": "78201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1679, "discounted_cash": 534, "minimum": 46.5, "maximum": 1343.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 587.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1291.22, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 747.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 801.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1189.57, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 427.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 282.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 282.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 310.43 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.29 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 640.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 550.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 560.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1141.12, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 858.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 534.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 603.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Tunneled Cv Cath With Pump", "code_information": [ { "code": "36563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19621.4, "discounted_cash": 5474, "minimum": 1582, "maximum": 15697.12, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5747.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6021.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13232.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7663.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8211.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12191.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4379.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5693.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6569.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5638.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5747.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11694.44, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8801.21, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5474.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6185.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13651, "minimum": 8281.17, "maximum": 25582.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12951.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15017.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19708.56 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17747.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18598.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25582.65 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12120.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20929.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12828.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16382.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14061.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14334.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13651.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14682.9 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19336.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14899.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13651.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8281.17 } ] } ] }, { "description": "INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES- SOI : 2", "code_information": [ { "code": "1762", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18205.84, "maximum": 19298.1904, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18205.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 19298.19, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 18205.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18205.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19116.13, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30689, "minimum": 4098.19, "maximum": 59958.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 28983.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 33758.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46191.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 39896.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 43588.78 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27603, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59958.65 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 29128.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 27603, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 42417.05 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 28707.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 27603, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36827.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 31610.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 32224.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30689.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37349.4 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 27603, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 45320.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 34920.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27603, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 30689.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4098.19 } ] } ] }, { "description": "Hc Apply Long Arm Cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992, "discounted_cash": 275, "minimum": 42.5, "maximum": 5594.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 302.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 665.12, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 385.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 412.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 612.76, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 220.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 275.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 283.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 288.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 587.8, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 442.38, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 992 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 275.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 310.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cmv Antibody", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 610, "discounted_cash": 14, "minimum": 11.51, "maximum": 488, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.44, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 68.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Injection Air/Contrast Peritoneal Cavity Spx", "code_information": [ { "code": "49400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2785, "minimum": 48, "maximum": 2228, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES - SOI : 1", "code_information": [ { "code": "3611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12560.8, "maximum": 13314.448, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12560.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13314.45, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12560.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12560.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13188.84, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ileoscopy Thru Stoma Stent W Dilation", "code_information": [ { "code": "44384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6618.67, "discounted_cash": 1887, "minimum": 776, "maximum": 5294.936, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2076.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4563.25, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2642.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4204.04, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1510.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1963.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2265.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1944.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4032.8, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3035.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2133.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tx Incomplete Abortion Any Trimester Surgical", "code_information": [ { "code": "59812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5584.28, "discounted_cash": 3184, "minimum": 776, "maximum": 5584.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3343.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3503.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5584.28, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4458.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4776.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5584.28, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2547.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3311.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3821.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3280.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3343.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5584.28, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5120.09, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3184.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3598.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Phys Therapy Re-Evaluation, 30 Min", "code_information": [ { "code": "97002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434, "minimum": 43.4, "maximum": 347.2, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 4", "code_information": [ { "code": "2824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20085.25, "maximum": 21290.365, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20085.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21290.37, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 20085.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20085.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21089.51, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Liver Dis 10 Assays W/Nash", "code_information": [ { "code": "0003M", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2517, "discounted_cash": 503, "minimum": 402.72, "maximum": 2013.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 528.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 553.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 503.4 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 704.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 755.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1065.04, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 402.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 523.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 604.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 518.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 528.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 604.08 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 604.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 568.84, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sensory Integration Ea 15 Min", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360, "discounted_cash": 62, "minimum": 50.368, "maximum": 288, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 69.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 88.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.98 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 157.98 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 156.46 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 66.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 69.26, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.61, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM - SOI : 1", "code_information": [ { "code": "6261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1179.76, "maximum": 1250.5456, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1179.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1250.55, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1179.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1179.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1238.75, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Egd Removal Tumor Polyp/Other Lesion Snare Tech", "code_information": [ { "code": "43251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 1887, "minimum": 200.7, "maximum": 3575.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2076.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2642.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1510.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1963.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2265.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1944.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1982.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3035.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1887.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2133.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tone Decay Hearing Test", "code_information": [ { "code": "92563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 36, "minimum": 14.21, "maximum": 122.04, "payers_information": [ { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 78.49, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.07, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 88.81, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.82, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 36.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.84, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT <1500G W MAJOR PROCEDURE - SOI : 2", "code_information": [ { "code": "5882", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 147487.85, "maximum": 156337.121, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 147487.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 156337.12, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 147487.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 147487.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 154862.24, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Renal Function Panel", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123, "discounted_cash": 8, "minimum": 6.94, "maximum": 98.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 32.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us,Pregnant Uterus,F/U,Transabd App", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 552, "discounted_cash": 102, "minimum": 39.78, "maximum": 441.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.78 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 172.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 172.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 190 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strep A Dna Amp Probe", "code_information": [ { "code": "87651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.32, "discounted_cash": 35, "minimum": 24.2, "maximum": 267.456, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 74.24, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 129.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Observation Per Hour", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $2005", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1947, "10th_percentile": 1947, "90th_percentile": 2005, "count": "107" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 4248, "10th_percentile": 2907, "90th_percentile": 5704, "count": "68" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 4342, "10th_percentile": 4342, "90th_percentile": 4968, "count": "1 through 10" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3253", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23746.25, "maximum": 25171.025, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 23746.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 25171.03, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 23746.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23746.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24933.56, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES- SOI : 1", "code_information": [ { "code": "0431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8200.84, "maximum": 8692.8904, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8200.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8692.89, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8200.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8200.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8610.88, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ct Scan Of Abdomen Combo", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3600, "discounted_cash": 172, "minimum": 111.5, "maximum": 2880, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 189.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 417.1, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 241.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 384.27, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 934.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 934.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1027.62 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 181.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.42, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 172.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 194.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Compatibility Test,Spin Tech", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82, "discounted_cash": 167, "minimum": 12, "maximum": 82, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 53.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Metabolic Panel,Comprehensive", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1364, "discounted_cash": 10, "minimum": 8.448, "maximum": 1091.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.69 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 39.07 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 4", "code_information": [ { "code": "7554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8001.82, "maximum": 8481.9292, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8001.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8481.93, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8001.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8001.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8401.91, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 1", "code_information": [ { "code": "9101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18985.51, "maximum": 20124.6406, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18985.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 20124.64, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 18985.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18985.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19934.79, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "REMOVAL OF BONE FOR GRAFT - 20900 - ", "code_information": [ { "code": "20900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2238.13, "discounted_cash": 7138, "minimum": 389.2108, "maximum": 2238.13, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2238.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2238.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2238.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2238.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2238.13 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2238.13, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Needle Biopsy,Muscle", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5384, "discounted_cash": 1624, "minimum": 776, "maximum": 4307.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3927.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2274.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2437.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3618.43, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3471.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2612.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS - SOI : 3", "code_information": [ { "code": "0483", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9599.44, "maximum": 10175.4064, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9599.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10175.41, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9599.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9599.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10079.41, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Glycosylated Hemoglobin Test", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249, "discounted_cash": 9, "minimum": 7, "maximum": 199.2, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 46.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 39.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 1", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5461.75, "maximum": 5789.455, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5461.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5789.46, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5461.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5461.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5734.84, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES - SOI : 2", "code_information": [ { "code": "3122", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16901.62, "maximum": 17915.7172, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16901.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 17915.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 16901.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16901.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17746.7, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS - SOI : 3", "code_information": [ { "code": "8903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14662.48, "maximum": 15542.2288, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14662.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15542.23, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14662.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14662.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15395.6, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [ { "code": "823", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39606, "minimum": 31498.7222, "maximum": 77949.99, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 37373.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 43567.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60051.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 51488.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 56668.13 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 77949.99 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 36587.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 35593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 54776.57 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 37017.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 35593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 47527.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 40794.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 41586.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39606.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56804.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 35593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 58919.26 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45398.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35593.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 39606.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28112, "minimum": 16961.06, "maximum": 54759.49, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 26558.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 30924.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42186.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 36546.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 39809.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54759.49 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16961.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 25293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 36576.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 26305.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 25293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33735.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 28956.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 29518.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28112.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18613.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 25293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 41390.5 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 31892.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25293.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28112.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thaw Plasma Fresh Frozen Ea Unit", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 167, "minimum": 22.5, "maximum": 75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40046, "minimum": 6979.7, "maximum": 78837.49, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 37787.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 44051.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60735.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 52060.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 57313.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35988, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 78837.49 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 56613.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 35988, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 58773.31 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 37427.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 35988, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 48055.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 41247.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 42048.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40046.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 70836.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 35988, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 59590.09 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45915.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35988, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 40046.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6979.7 } ] } ] }, { "description": "Hc Assay Of Phenothiazine - 80342 - 30100385", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 918, "minimum": 16.48, "maximum": 734.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.15 } ] } ] }, { "description": "Hc Exchange Nephrostomy Cath, Perq", "code_information": [ { "code": "50435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3500, "discounted_cash": 2056, "minimum": 608.65, "maximum": 3500, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2262.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3500, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2879.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3084.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3500, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1645.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2056.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2467.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2118.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2159.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3500, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3306.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2056.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2323.8, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Decalcify Tissue", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 673, "minimum": 6.19, "maximum": 538.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 126.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 108.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.99 } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [ { "code": "918", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8194, "minimum": 4663.17, "maximum": 14572.27, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9014.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11226.3 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10653.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10593.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7444.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14572.27 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4663.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7444.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10859.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7742.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7444.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9833.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8440.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8604.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8194.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5920.61 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7444.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 11014.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8487 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7444.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8194.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY - SOI : 4", "code_information": [ { "code": "4824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20020.96, "maximum": 21222.2176, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20020.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21222.22, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 20020.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20020.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21022.01, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 4", "code_information": [ { "code": "3834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14594.08, "maximum": 15469.7248, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14594.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15469.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14594.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14594.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15323.78, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22844, "minimum": 8386.87, "maximum": 44129.95, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 21601.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 25128.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33997.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29697.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 32081.62 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20572.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44129.95 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22774.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 20572.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 32145.58 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 21395.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 20572.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27413.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23529.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 23986.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22844.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31602.9 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 20572.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 33356.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 25701.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20572.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22844.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8386.87 } ] } ] }, { "description": "PANCREAS TRANSPLANT", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 61439, "minimum": 13893.34, "maximum": 122000.03, "payers_information": [ { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 64511.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 61439.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 94546 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 55158.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 92214.92 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 71053.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 55158.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 61439.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13893.34 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 57916.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 67583.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 93987.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 79870.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 88691.65 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55158.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 122000.03 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 41498.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 55158.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 54651.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 57364.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 55158.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 73726.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 63282.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20316, "minimum": 5394.16, "maximum": 39029.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 19222.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 22348.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30067.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26411.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 28373.62 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39029.4 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14694.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 18307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 29997.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 19039.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 18307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24379.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20926.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 21332.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20316.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28065.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 18307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 29500.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 22731.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20316.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5394.16 } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "419", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12481, "minimum": 9383.3875, "maximum": 23221.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11850.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 13729.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17889.25 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16225.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 16881.29 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11286, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23221.1 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11583.36 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11286, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17020.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11737.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 11286, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14977.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12855.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 13105.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12481.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16712.7 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11286, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 17551.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13524.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11286, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12481.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10232.27 } ] } ] }, { "description": "OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS - SOI : 2", "code_information": [ { "code": "6632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5965.8, "maximum": 6323.748, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5965.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6323.75, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5965.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5965.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6264.09, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITH CCMCC", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16235, "minimum": 10077.02, "maximum": 33557.87, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15382.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17859.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23724.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21106.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 22387.67 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14650.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30795.41 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 33557.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14650.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21665.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15236.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 14650.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19482.61, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16722.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 17047.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16235.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16748 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14650.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 23277.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17935.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14650.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16235.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10077.02 } ] } ] }, { "description": "Hc Slctv Cath Intrcrnl Brnch Angio Intrl Carot/Vert", "code_information": [ { "code": "36228", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8386, "minimum": 187.5, "maximum": 6708.8, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.5 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "Hc Pulmonary Stress Testing, Complex", "code_information": [ { "code": "94621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1101.75, "discounted_cash": 367, "minimum": 63.56, "maximum": 887.3846, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 403.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 887.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 513.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 550.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 817.53, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 293.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 680.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 680.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 674.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 381.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 378.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 385.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 784.23, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 590.21, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 3", "code_information": [ { "code": "7583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7270.71, "maximum": 7706.9526, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7270.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7706.95, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7270.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7270.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7634.25, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Colonoscopy,Biopsy", "code_information": [ { "code": "45380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3002.69, "discounted_cash": 1177, "minimum": 238.9, "maximum": 3002.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1294.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2845.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1648.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1765.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2621.67, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 941.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 238.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1224.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1412.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3002.69 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1212.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1236.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 320 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2514.88, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1892.69, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1177.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1330.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Vasopneumatic Device Therapy", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157, "discounted_cash": 12, "minimum": 9.944, "maximum": 157, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 157, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.22 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.3, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 98.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 97.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fine Needle Aspiration Bx W/Mr Gdn Ea Addl", "code_information": [ { "code": "10012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500, "minimum": 86.95, "maximum": 500, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 500 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 500 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 500 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 500 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 500 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 500 } ] } ] }, { "description": "Hc Fern Test - 87210 - 30600080", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228, "discounted_cash": 5, "minimum": 4.656, "maximum": 182.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ex For Nonspeech Device Rx Init Hr", "code_information": [ { "code": "92605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 652, "minimum": 113.3828, "maximum": 521.6, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180 } ] } ] }, { "description": "Hc Clsd Treat Prox/Shaft Fibula Fx Wo Manip", "code_information": [ { "code": "27780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2234, "discounted_cash": 242, "minimum": 115.5, "maximum": 2040, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 2", "code_information": [ { "code": "0562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7567.53, "maximum": 8021.5818, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7567.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8021.58, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7567.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7567.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7945.91, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OPEN CRANIOTOMY FOR TRAUMA- SOI : 3", "code_information": [ { "code": "0203", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28348.32, "maximum": 30049.2192, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 28348.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 30049.22, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 28348.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28348.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29765.74, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repair Mouth Laceration,<2.5 Cm", "code_information": [ { "code": "40830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402, "discounted_cash": 233, "minimum": 69.9078, "maximum": 402, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 256.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 326.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 186.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 239.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 244.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 402 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 402, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 374.61, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 402 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 233, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 263.29, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "465", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16340, "minimum": 4915.19, "maximum": 31006.24, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15480.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17974, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23886.82 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21242, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 22540.93 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14743.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31006.24 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 17823.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14743.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 23271.62 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15333.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 14743.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19608, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16830.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 17157, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19632.4 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14743.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 23436.37 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 18058.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14743.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16340, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4915.19 } ] } ] }, { "description": "Hc X-Ray Retrograde Pyelogram", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1898.63, "discounted_cash": 343, "minimum": 22.5, "maximum": 1518.904, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 277.45 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 277.45 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 305.08 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% 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": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Lumbar Spine W Contrast", "code_information": [ { "code": "72132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2965, "discounted_cash": 343, "minimum": 94, "maximum": 2372, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 377.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 829.64, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 480.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 514.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 764.33, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 274.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 786.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 786.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 864.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.64 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "One Call Care", "plan_name": "One Call Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "One Call Care", "plan_name": "One Call Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 411.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 360.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 733.19, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 551.8, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 343.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 387.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Slct Cor Angio During Congenital Heart Cath", "code_information": [ { "code": "93563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174, "minimum": 30.2586, "maximum": 174, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 174 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 174 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 174 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 1", "code_information": [ { "code": "2401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6091.64, "maximum": 6457.1384, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6091.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6457.14, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6091.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6091.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6396.22, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bone Marrow Aspirate &Biopsy", "code_information": [ { "code": "G0364", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.35, "minimum": 55.835, "maximum": 558.35, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 558.35 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 558.35 } ] } ] }, { "description": "Hc Perq Cath Drn W Img Peri/Retro", "code_information": [ { "code": "49406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6516.99, "discounted_cash": 1624, "minimum": 173.63, "maximum": 5213.592, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3927.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2274.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2437.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.63 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3618.43, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 184 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3471.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2612.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acid Single Qual", "code_information": [ { "code": "82127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.7, "discounted_cash": 14, "minimum": 11.34, "maximum": 150.96, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.18 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 60.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 51.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SYNCOPE & COLLAPSE - SOI : 2", "code_information": [ { "code": "2042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5766.1, "maximum": 6112.066, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5766.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6112.07, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5766.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5766.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6054.41, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Excision Ganglion Wrist, Primary", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1581, "minimum": 854, "maximum": 4869.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1740.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3823.9, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2214.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3522.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1265.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1645.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1629.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3379.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1787.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Les Sbq 2 Cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7533, "discounted_cash": 1624, "minimum": 776, "maximum": 6026.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3927.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2274.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2437.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3618.43, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3471.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2612.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [ { "code": "486", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18593, "minimum": 12050.14, "maximum": 54518.53, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 17601.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 20452.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27389.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24171.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 25846 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35552.53 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12050.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 27738.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 17433.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22311.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19151.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 19522.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18593.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18660.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 26872.73 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 20706.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18593.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 54518.53 } ] } ] }, { "description": "Hc Home Sleep Test/Type 3 Porta - 95806 - 74000034", "code_information": [ { "code": "95806", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 635.5, "discounted_cash": 212, "minimum": 110.5135, "maximum": 513.4551, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 473.04, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 216.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 164.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 218.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 223.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 453.77, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.51, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 212.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 240.02, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 233.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 513.46, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 297.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.62, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Skin Benig 2.1-3 Cm Face/Head/Mucus", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1624, "minimum": 454.38, "maximum": 4946.48, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1787.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3927.6, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2274.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2437.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3618.43, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1299.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1673.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1706.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3471.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2612.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1624.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abl1 Gene Analysis Kinase Domain Variants", "code_information": [ { "code": "81170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 300, "minimum": 240, "maximum": 769.824, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 240 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 330, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 634.71, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 240, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 440.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 440.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 376.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 312, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 360, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 309, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 315, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 360, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 360, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 297.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 339, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Phleb Veins Extrem < 20", "code_information": [ { "code": "37766", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11803, "discounted_cash": 3106, "minimum": 776, "maximum": 9442.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7508.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6917.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Distruct Tumor/Stenosis Laser/Cryo", "code_information": [ { "code": "31641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15451.8, "discounted_cash": 3667, "minimum": 776, "maximum": 12361.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3851.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4034.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8866.23, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5134.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5501.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3667.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8168.3, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2934.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3667.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3814.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3667.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4401.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3777.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3851.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3667.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3667.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7835.58, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5897.04, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3667.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3667.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4144.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Transferase Alanine Amino (Alt) (Sgpt)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178, "discounted_cash": 5, "minimum": 4.24, "maximum": 142.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.24 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.36 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drain Blood From Under Nail", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 130, "minimum": 89.2872, "maximum": 513.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.49, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 513.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Removal Tunld Cv Cath W Subq Port/Pump", "code_information": [ { "code": "36590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6437.62, "discounted_cash": 1548, "minimum": 1090.5, "maximum": 5150.096, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1626.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1703.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3743.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2168.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2322.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3448.73, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1238.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1610.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1858.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1595.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1626.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3308.25, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.78, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1548.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1749.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ecg Signal Averaged", "code_information": [ { "code": "93278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619, "discounted_cash": 58, "minimum": 21.53, "maximum": 520.02, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 520.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 520.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 514.99 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient Established Sf Mdm 10-19 Min - G0463 - 76100007", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1249.13, "discounted_cash": 130, "minimum": 32.1715, "maximum": 999.304, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 144.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.62, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.69, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.81, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.59, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rbc Osmotic Fragility", "code_information": [ { "code": "85555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.86, "discounted_cash": 7, "minimum": 3, "maximum": 47.088, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc I&D Pelvis/Hip,Infect Bursa", "code_information": [ { "code": "26991", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 1581, "minimum": 776, "maximum": 9753.36, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1740.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3823.9, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2214.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3522.89, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1265.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1645.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1629.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1661, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3379.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1581.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1787.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Cplx Trunk 1.1-2.5 Cm", "code_information": [ { "code": "13100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2265.5, "discounted_cash": 727, "minimum": 393.9705, "maximum": 2265.5, "payers_information": [ { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 748.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 763.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1553.25, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1168.97, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 821.6, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 763.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 799.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1757.56, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1017.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1090.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1619.21, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 581.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2265.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2265.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2265.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 727.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 872.5, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12812.6, "discounted_cash": 3106, "minimum": 22.5, "maximum": 10250.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7508.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6917.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% 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": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniocentesis,Diagnostic", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855, "discounted_cash": 906, "minimum": 148.6845, "maximum": 855, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 855 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 724.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 855 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 855 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 855 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 855 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 855 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 855, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DRUG ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7763", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7265.92, "maximum": 7701.8752, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7265.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7701.88, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7265.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7265.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7629.22, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "VIRAL ILLNESS WITH MCC", "code_information": [ { "code": "865", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13597, "minimum": 10293.6956, "maximum": 25473.84, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12900.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14957.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19624.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17677.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18518.99 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25473.84 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13350.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17934.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12778.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 12286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16317.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14005.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 14277.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13597.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11749.3 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 19254.65 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14836.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13597.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9872, "minimum": 3695.2, "maximum": 17957.33, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10859.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13834.11 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12834.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 13054.63 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8948.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17957.33 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8076.66 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8948.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13780.98 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9306.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8948.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11847.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10168.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 10366.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10782.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8948.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 13573.23 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10458.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8948.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9872.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3695.2 } ] } ] }, { "description": "OTHER COMPLICATIONS OF TREATMENT - SOI : 3", "code_information": [ { "code": "8133", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9260.22, "maximum": 9815.8332, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9260.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9815.83, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9260.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9260.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9723.23, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc R&L Heart Cath Inj Vetriculography, Rs/I", "code_information": [ { "code": "93453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22444, "discounted_cash": 3189, "minimum": 1582, "maximum": 17955.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3348.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3508.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7709.51, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4465.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4784, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7102.64, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2551.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 8028.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8028.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 8028.24 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3316.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3827.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3285.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3348.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6813.32, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5127.69, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3189.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3603.94, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Device Placemt Breast Loc Ea Les W Guidnce", "code_information": [ { "code": "19282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 550, "minimum": 39.33, "maximum": 550, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 550 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 550 } ] } ] }, { "description": "DILATION AND CURETTAGE", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3081, "discounted_cash": 3184, "minimum": 535.7859, "maximum": 3081, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2547.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3081 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3081 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 726 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3081, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 4", "code_information": [ { "code": "9514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31964.87, "maximum": 33882.7622, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 31964.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 33882.76, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 31964.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31964.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33563.11, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [ { "code": "805", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10066, "minimum": 4273.27, "maximum": 18348.37, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9577.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11073.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14135.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13086.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 13338.91 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18348.37 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4273.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13725.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9486.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 9121.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12079.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10368.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 10569.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10066.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6172.73 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9121.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 13868.8 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10686.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10066.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INBORN ERRORS OF METABOLISM - SOI : 1", "code_information": [ { "code": "4231", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5252.47, "maximum": 5567.6182, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5252.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5567.62, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5252.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5252.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5515.09, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Us Guide Amniocentesis", "code_information": [ { "code": "76946", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500, "minimum": 18.6, "maximum": 400, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.02 } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE - SOI : 2", "code_information": [ { "code": "6312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29320.85, "maximum": 31080.101, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 29320.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 31080.1, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 29320.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29320.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30786.89, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Hemorrhoidectomy Intrn Ligation Not Rbbr Bnd Sing", "code_information": [ { "code": "46945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10837.5, "discounted_cash": 2730, "minimum": 454.38, "maximum": 8670, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2867.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3003.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6600.68, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3822.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4095.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2730.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6081.09, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2184.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2730.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2839.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2730.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3276.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2812.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2867.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2730.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2730.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5833.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4390.2, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2730.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2730.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3085.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bacterium, Antibody", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348, "discounted_cash": 12, "minimum": 8.9, "maximum": 278.4, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.25, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.25% W/ Epinephrine 1:200000 (Pf) - 00409904201", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00409904201", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 31.16, "10th_percentile": 18.34, "90th_percentile": 32.97, "count": "1 through 10" } ] } ] }, { "description": "Hc Trim Benign Hyperkeratotic Skin Lesion,>4", "code_information": [ { "code": "11057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 417.85, "discounted_cash": 197, "minimum": 72.6641, "maximum": 417.85, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 217.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 417.85, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 417.85 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 417.85, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 417.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 417.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 417.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 417.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 203.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 207.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 417.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 417.85, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 317.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 417.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 223.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29895 - ", "code_information": [ { "code": "29895", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3533.25, "discounted_cash": 3218, "minimum": 614.4322, "maximum": 3533.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3533.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3533.25, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3533.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3533.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3533.25, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2575.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3533.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3533.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3533.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3533.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3533.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3315.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3379.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 932 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3533.25, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3533.25, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3218.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3533.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Destruc Benign/Premal,First Lesion", "code_information": [ { "code": "17000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.6, "discounted_cash": 197, "minimum": 133.1378, "maximum": 765.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 217.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 477.12, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 765.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 439.57, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 765.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 203.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 207.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 765.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 421.66, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 317.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 765.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 223.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Radex Spine Cervical 2 Or 3 Views", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 457.28, "discounted_cash": 85, "minimum": 16.5, "maximum": 365.824, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 94.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 206.94, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 119.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 190.65, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 68.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 82.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 90.99 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.03, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 89.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 182.89, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.64, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 85.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.74, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Face 7.6-12.5 Cm", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1602.81, "discounted_cash": 399, "minimum": 278.7287, "maximum": 1602.81, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 439.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.7, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 559.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 599.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 319.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 479.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 411.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 419.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.32, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.96, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1602.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 399.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 451.9, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Humeral Supracondylar Fx Wo Manip", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 242, "minimum": 123.5, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY W STERILIZATION &OR D&C - SOI : 4", "code_information": [ { "code": "5414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14759.59, "maximum": 15645.1654, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14759.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15645.17, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14759.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14759.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15497.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Exc Skin Malig 1.1-2 Cm Scalp/Neck/Hnd/Ft/Gent", "code_information": [ { "code": "11622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 696, "minimum": 454.38, "maximum": 2695.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 766.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1683.98, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 975.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1551.42, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 557.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 724.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 835.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 717.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1488.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1120.03, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 787.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Myocardial Spect Multiple Studies", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5707.73, "discounted_cash": 1273, "minimum": 278.34, "maximum": 4566.184, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1439.21, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1337.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1401, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3078.75, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1783.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1910.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2836.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1018.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1241.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1241.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1364.81 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 2046.67, "10th_percentile": 1874.67, "90th_percentile": 2046.67, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 295.04 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1324.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1528.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1311.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1337.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1273.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2720.86, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2047.71, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 314.52 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25798, "minimum": 11250, "maximum": 128137.37, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 24380.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 28377.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38588.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 33537.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 36413.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23219.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 50089.09 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22706.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 23219.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 36278.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 24148.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 23219.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30957.61, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 26571.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 27087.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29457.8 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 23219.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 37860.33 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 29172.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23219.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 25798.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 128137.37 } ] } ] }, { "description": "LIVER TRANSPLANT &OR INTESTINAL TRANSPLANT - SOI : 1", "code_information": [ { "code": "0011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 47370.07, "maximum": 50212.2742, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 47370.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 50212.27, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 47370.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 47370.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 49738.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Insert Tunneled Cv Cath W/O Port Or Pump", "code_information": [ { "code": "36558", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12812.6, "discounted_cash": 3106, "minimum": 1189.9977, "maximum": 10250.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7508.66, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4659.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6917.6, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2484.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3230.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3727.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3199.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6635.82, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4994.1, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3510.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5742, "minimum": 3655.82, "maximum": 10084.73, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 5509.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 6316.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7414.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 7465.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 6997 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5247.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9624.74 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3655.82 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 5247.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 8322.24 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 5457.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 5247.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 6891.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 5915, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 6029.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5742.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4818.1 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 5247.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 7274.95 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 5605.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5247.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5742.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10084.73 } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1651", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29338.63, "maximum": 31098.9478, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 29338.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 31098.95, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 29338.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29338.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30805.56, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Strapping Hand Or Finger", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341, "discounted_cash": 58, "minimum": 46.424, "maximum": 341, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.27, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 129.23, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 341 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 341 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 341 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 123.97, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 341 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 58.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nasal Endo Sx,Control Of Nasal Hemorrhage", "code_information": [ { "code": "31238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6348.95, "discounted_cash": 1751, "minimum": 776, "maximum": 5079.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1838.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1926.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4232.71, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2451.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2626.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3899.52, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1821.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2101.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1803.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1838.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3740.68, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2815.23, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1751.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1978.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Musculoskeletal Nuclear Exam", "code_information": [ { "code": "78399", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 393, "minimum": 249.14, "maximum": 1865.248, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 432.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 950.67, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 550.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 875.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 314.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 409.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 471.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 412.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 840.16, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 632.3, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 249.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 393.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 444.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Penile Vascular Study,Ltd Or F/U", "code_information": [ { "code": "93981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1948, "discounted_cash": 102, "minimum": 57, "maximum": 1558.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1137.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1137.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1126.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Diag W Needle Asp Bx, Single Lobe", "code_information": [ { "code": "31629", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2308, "discounted_cash": 3667, "minimum": 401.3612, "maximum": 2308, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2308 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2308 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2308 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2308 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2308, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fecal Blood Scrn Immunoassay", "code_information": [ { "code": "G0328", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35, "discounted_cash": 18, "minimum": 9.03, "maximum": 35, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.22 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Egd Flex Removal Lesion Hot Bx/Bipolar Cautery", "code_information": [ { "code": "43250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1244, "discounted_cash": 1887, "minimum": 216.3316, "maximum": 1244, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1244 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 1244 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1244 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1244 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1244 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1244 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1244, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Npm1 Nucleophosmin Gene Analysis Exon 12 Variants", "code_information": [ { "code": "81310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 741.72, "discounted_cash": 246, "minimum": 197.216, "maximum": 593.376, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 197.22 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 258.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 271.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 246.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 345.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 369.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.22 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 521.56, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 329.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 329.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 282.06 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 246.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 295.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 258.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 295.82, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 295.82, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 222.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 246.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 278.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Skull 4+ Vw", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 644, "discounted_cash": 102, "minimum": 27.49, "maximum": 515.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.49 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 121.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 133.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Therapeutic Exercises Complex, Ea 15 Min", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211, "discounted_cash": 29, "minimum": 8.38, "maximum": 180, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.39, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 163.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 161.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 29.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 32.96, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.92, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 32.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 } ] } ] }, { "description": "Hc Hepatitis B Dna Amp Probe", "code_information": [ { "code": "87516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 742, "discounted_cash": 35, "minimum": 24.2, "maximum": 593.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 74.24, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 129.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% 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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Trlml Blln Angiop Open/Perq Img S&I Init Art", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25425, "discounted_cash": 5599, "minimum": 309.3, "maximum": 20340, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5879.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6159.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13534.88, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7838.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8398.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5599.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12469.44, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4479.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5599.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5823.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 5599.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6719.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5767.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 5879.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5599.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5599.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11961.51, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9002.21, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5599.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5599.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6327.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CCMCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7334, "minimum": 5187.0387, "maximum": 12836.38, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7007.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8067.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9888.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9534.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9331.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6673.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12836.38 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5337.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6673.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 12533.53 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6940.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 6673.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8801.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7554.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 7701.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7334.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8529.43 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6673.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 9702.51 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7476.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6673.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7334.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12269.26 } ] } ] }, { "description": "Hc Cytopath C/V Auto Rescreen", "code_information": [ { "code": "88148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.12, "discounted_cash": 18, "minimum": 12.5, "maximum": 148.896, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.54 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.23, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 21.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Human Epididymis Protein 4 (He4)", "code_information": [ { "code": "86305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327, "discounted_cash": 20, "minimum": 16.648, "maximum": 261.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.65 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% 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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Skin Malig >4 Cm Scalp/Neck/Hnd/Ft/Gent", "code_information": [ { "code": "11626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 2857, "minimum": 776, "maximum": 8595.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3143.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6907.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4000.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4286.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6363.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2286.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2971.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3429.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2943.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6104.61, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4594.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3229.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Gr Tuberosity Hum Fx Wo Manip", "code_information": [ { "code": "23620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 242, "minimum": 157, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 266.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 586.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.4, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 518.39, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.14, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 242.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Immunofluor Ea Add Single Antibody Stain", "code_information": [ { "code": "88350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277, "minimum": 12.03, "maximum": 221.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 93.17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.59 } ] } ] }, { "description": "Hc Assay Of Quinidine", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182, "discounted_cash": 14, "minimum": 11.68, "maximum": 145.6, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.68 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.89, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 70.35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 60.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nasopharyngoscopy With Endoscope", "code_information": [ { "code": "92511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 543, "discounted_cash": 196, "minimum": 61.456, "maximum": 437.2937, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 274.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 437.29, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 157.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 61.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 93.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 235.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 206.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 419.48, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 196.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 221.89, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 550, "discounted_cash": 18, "minimum": 14.44, "maximum": 440, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.44 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.19, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 87.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 75.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.66 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Gerd Tst W/ Mucos Ph Electrod", "code_information": [ { "code": "91035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2541.16, "discounted_cash": 844, "minimum": 285.85, "maximum": 2541.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 887.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 929.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2042.12, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1182.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1267.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1881.37, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 675.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 347.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 347.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 365.88 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1013.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2541.16 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 870.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 887.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1804.73, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1358.24, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 954.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR - SOI : 1", "code_information": [ { "code": "6941", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5547.24, "maximum": 5880.0744, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5547.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5880.07, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5547.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5547.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5824.6, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Igg 1 2 3 Or 4 Each", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211, "discounted_cash": 8, "minimum": 6.416, "maximum": 168.8, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.42 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.97, "additional_payer_notes": "Laboratory - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 35.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 30.51 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.62 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION - SOI : 4", "code_information": [ { "code": "6394", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23944.58, "maximum": 25381.2548, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 23944.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 25381.25, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 23944.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23944.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25141.81, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Exc Skin Malig 3.1-4 Cm Trnk/Arm/Leg", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 696, "minimum": 468.7561, "maximum": 2695.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 766.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1683.98, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 975.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1551.42, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 557.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 724.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 835.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 717.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 731.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1488.22, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1120.03, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 696.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 787.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SIGNIFICANT HIP & FEMUR SURGERY - SOI : 2", "code_information": [ { "code": "3092", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15403.16, "maximum": 16327.3496, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15403.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16327.35, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15403.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15403.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16173.32, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8129, "minimum": 4829.38, "maximum": 14441.35, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7755.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8942.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11125.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10568.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10498.58 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7386.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14441.35 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4829.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7386.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 12663.67 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7682, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 7386.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9755.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8373.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 8536.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8129.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7785.89 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7386.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 10915.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8410.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7386.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8129.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 4", "code_information": [ { "code": "3164", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24099.83, "maximum": 25545.8198, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24099.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 25545.82, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 24099.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24099.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25304.82, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Duplex Scan Extracranial,Bilat", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1652, "discounted_cash": 234, "minimum": 119.34, "maximum": 1321.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 258.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 567.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 328.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.72, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 1202.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1202.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1190.92 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 495.6, "10th_percentile": 495.6, "90th_percentile": 983.1, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 281.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 501.43, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 377.37, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 234.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE, BIRTHWT >2499G W RESP DIST SYNDOTH MAJ RESP COND - SOI : 1", "code_information": [ { "code": "6341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5507.58, "maximum": 5838.0348, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5507.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5838.03, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5507.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5507.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5782.96, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 4", "code_information": [ { "code": "7224", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10426.98, "maximum": 11052.5988, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10426.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11052.6, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10426.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10426.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10948.33, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE - SOI : 4", "code_information": [ { "code": "7104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34634.19, "maximum": 36712.2414, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 34634.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 36712.24, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 34634.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34634.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 36365.9, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ro Radn Treatment Aid(S) Intermed", "code_information": [ { "code": "77333", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1285, "discounted_cash": 132, "minimum": 16.97, "maximum": 1028, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 145.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.61, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 185.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 198.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.97 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 294.45, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 143.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 151.23 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.99 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 158.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 136.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 138.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 282.46, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.58, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 132.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 149.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Joint Survey Single Vw", "code_information": [ { "code": "77077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 376, "discounted_cash": 102, "minimum": 23.32, "maximum": 300.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 113.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 248.59, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 229.02, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 187.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 206.06 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.72 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 107.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.34, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 116.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert,Non-Indwelling Bladder Catheter", "code_information": [ { "code": "51701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 130, "minimum": 89.2872, "maximum": 513.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 143.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.4, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 183.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 196.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.49, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 137.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.62, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.44, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 513.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 130.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Group Therapeutic Procedures", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97, "discounted_cash": 18, "minimum": 14.88, "maximum": 97, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.35, "additional_payer_notes": "A Indicator - 211.57% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 43.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rbc Pretreatment,Serum Inhib", "code_information": [ { "code": "86977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 167, "minimum": 25, "maximum": 412.08, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 25 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 184.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 405.14, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 234.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 373.25, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 134.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 92.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 79.45 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 175.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 358.04, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.46, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 167.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 189.39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophageal Motility Study, Manometry", "code_information": [ { "code": "91010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2541.16, "discounted_cash": 367, "minimum": 16.5, "maximum": 2541.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 403.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 887.38, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 513.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 550.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 817.53, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 293.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 301.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 301.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 317.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 381.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2541.16 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 378.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 385.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 784.23, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 590.21, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CCMCC", "code_information": [ { "code": "842", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9486, "minimum": 6941.7006, "maximum": 17178.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9032.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10435.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13234.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12332.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12488.54 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17178.65 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8243.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14873.66 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8946.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8602.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11383.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9771.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 9960.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9486.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8756.99 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8602.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 12984.65 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10004.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9486.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Plc Cath Subsubselect Art,Neck", "code_information": [ { "code": "36217", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2622, "minimum": 320.2, "maximum": 2622, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2622 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2622 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2622 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 320.2 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2622 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY - SOI : 1", "code_information": [ { "code": "5111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10955.65, "maximum": 11612.989, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10955.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11612.99, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10955.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10955.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11503.43, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19363, "minimum": 7652.46, "maximum": 37106.49, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7652.46 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 18325.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 21299.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28586.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25172.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 26975.7 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37106.49 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 21086.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 17453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 32057.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 18151.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 17453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23236.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19944.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 20331.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19363.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23355.5 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 17453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 28047.31 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 21611.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19363.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exhaled Air Analysis: O2, Co2", "code_information": [ { "code": "94681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 569, "discounted_cash": 367, "minimum": 22.5, "maximum": 569, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 403.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 569, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 513.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 550.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 569, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 293.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "fee schedule", "standard_charge_dollar": 294.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 294.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 291.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 381.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 378.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 385.46, "additional_payer_notes": "105.00% 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": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 569, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 569, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 367.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [ { "code": "071", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9618, "minimum": 7048.8765, "maximum": 17443.88, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9156.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10579.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13438.55 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12503.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12681.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8720.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17443.88 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8097.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8720.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13287.39 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9068.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "case rate", "standard_charge_dollar": 8720.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11541.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9906.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "case rate", "standard_charge_dollar": 10099.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9618.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9939.62 }, { "payer_name": "UBH (Optum)", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8720.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 13185.13 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10159.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8720.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9618.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7165.78 } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7188, "discounted_cash": 2857, "minimum": 776, "maximum": 6907.5796, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3143.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6907.58, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4000.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4286.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6363.83, "additional_payer_notes": "222.70% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2286.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC HMO/PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2971.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Dual", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3429.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500 }, { "payer_name": "Provider Patners Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2943.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan Plan PA", "plan_name": "Spartan Plan PA", "methodology": "fee schedule", "standard_charge_dollar": 3000.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6104.61, "additional_payer_notes": "213.63% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4594.32, "additional_payer_notes": "160.78% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2857.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3229.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4434, "discounted_cash": 3106, "minimum": 22.5, "maximum": 10250.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3416.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4434, "additional_payer_notes": "241.73% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4348.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4434, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3106.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4434, "additional_payer_n