{ "hospital_name": "Providence Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Providence Medical Center" ], "hospital_address": [ "8929 Parallel Parkway Kansas City, KS 66112" ], "license_information": { "license_number": "462162669", "state": "KS" }, "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": "Karen Orr" }, "type_2_npi": [ "1528301900" ], "standard_charge_information": [ { "description": "*11ADDL NECK SPINE FUSION", "code_information": [ { "code": "22552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2824.64, "minimum": 802.25, "maximum": 2824.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 802.25 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2824.64 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2824.64 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8333, "minimum": 3440.74, "maximum": 12916.4135, "payers_information": [ { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8333.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12916.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6382.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3440.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8333.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7336.49 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10575.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11666.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3440.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8333.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8333.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10806.1 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11666.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6580.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12288.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3509.55, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8333.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7369.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11754.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 8773.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3509.55, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11249.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12499.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8333.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10833.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10833.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8333.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3509.55, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8749.83, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7269, "minimum": 3904.66, "maximum": 11267.8025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10310.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3982.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7269.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6183.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9862.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7361.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3982.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7633.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9813.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10904.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7269.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9450.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9450.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7269.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3982.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7633.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7633.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7269.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11267.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7509.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3904.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7269.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3942.42 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8873.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10177.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3904.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7269.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7269.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9066.69 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10177.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7741.36 } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8053, "minimum": 866, "maximum": 12600, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11767.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3746.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "per diem", "standard_charge_dollar": 866 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11256.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "per diem", "standard_charge_dollar": 1030 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3746.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10871.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12079.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8053.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10469.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10469.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8053.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3746.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8455.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8053.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12482.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6680.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5645.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10127.23 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11274.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8053.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10348.08 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11274.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6887.12 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12973, "minimum": 6618.83, "maximum": 22950, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20918.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9306.24, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 12545.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 20009.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14935.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9306.24, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13622.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17514.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 19460.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16865.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16865.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9306.24, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13622.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13622.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20109.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11847.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9123.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6618.83 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18002.67 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18163.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9123.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18395.26 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 18163.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12213.96 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19559, "minimum": 14458.84, "maximum": 33300, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 33164.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 14748.02, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19559.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 19890.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 31724.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 23679.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 14748.02, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 20537.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26404.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 29338.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 19559.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 25426.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25426.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 19559.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14748.02, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 20537.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 20537.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 19559.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 30316.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 19878.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14458.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19559.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25698.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 28542.29 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 27382.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14458.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19559.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19559.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 29164.72 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 27382.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20493.4 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7852, "minimum": 4948.48, "maximum": 15750, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11393.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5047.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7852.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6833.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10898.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 8134.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5047.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8244.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10600.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11778.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7852.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10207.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10207.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7852.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5047.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8244.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8244.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7852.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12170.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8888.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4948.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7852.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9339.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9805.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10992.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4948.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7852.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7852.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10019.38 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10992.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9163.32 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15470, "minimum": 7616.02, "maximum": 25561.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25561.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7768.34, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 15330.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 24451.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 18250.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7768.34, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 16244.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20885.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 23206.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 15470.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 20111.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20111.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15470.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7768.34, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16244.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16244.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15470.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 15459.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7616.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15470.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17344.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21998.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21659.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7616.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15470.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22478.67 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 21659.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15937.96 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37903, "minimum": 20064.54, "maximum": 78269.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 67278.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 20465.83, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 40350.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 64358.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 48036.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 20465.83, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 39798.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 51169.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 56855.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 37903.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 49274.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 49274.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 37903.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20465.83, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 39798.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 39798.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 37903.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 58750.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 40767.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20064.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37903.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78269.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 57901.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 53064.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20064.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37903.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 37903.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 59164.65 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 53064.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42028 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9761, "minimum": 4445.9, "maximum": 15130.8985, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14944.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4534.82, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9761.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8963.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14296.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10670.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4534.82, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10249.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13178.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 14642.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9761.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12690.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12690.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9761.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4534.82, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10249.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10249.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9761.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15130.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11565.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4445.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9761.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12122.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12862.07 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13666.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4445.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9761.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9761.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13142.55 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13666.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11922.88 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9391, "minimum": 4149.55, "maximum": 18450, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14256.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4613.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9391.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8550.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13637.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10178.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9861.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12678.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 14087.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9391.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12208.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12208.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9391.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4613.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9861.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9861.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9391.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14556.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 9032.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4523.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9391.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4149.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12269.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13148.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4523.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9391.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9391.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12536.88 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13148.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9312.28 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6903, "minimum": 2660.94, "maximum": 12150, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9629.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3115.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6903.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5775.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9211.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6875.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3115.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7249, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9320.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10355.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6903.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8974.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8974.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6903.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3115.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7249, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7249, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6903.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10700.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5092.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3054.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6903.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2660.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8287.83 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9665.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3054.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6903.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6903.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8468.57 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9665.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5250.08 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7782, "minimum": 6610.86, "maximum": 12062.4875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11263.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6743.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7782.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6755.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10774.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 8042.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6743.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8171.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10506.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11673.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7782.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10116.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10116.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7782.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6743.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8171.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8171.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10800, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7782.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12062.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6771.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6610.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7782.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8826.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9693.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10895.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6610.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7782.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7782.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9905.14 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10895.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6981.36 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12296, "minimum": 6920.14, "maximum": 19658.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19658.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7058.54, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12296.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11790.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 18804.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14035.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7058.54, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12911.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16600.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18444.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12296.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15985.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15985.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12296.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7058.54, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12911.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12911.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12296.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19059.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11842.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6920.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12296.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13093.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16918.44 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17214.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6920.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12296.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12296.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17287.39 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17214.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12208.64 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6490, "minimum": 5283.51, "maximum": 10060.461, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8861.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6427.61, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6490.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5314.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8476.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6327.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6427.61, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8762.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9735.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6490.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8437.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8437.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6490.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6427.61, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6815.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6490.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10060.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5283.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6301.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6490.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7917.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7626.54 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9086.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6301.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6490.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6490.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7792.85 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9086.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5446.92 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6286, "minimum": 3711.36, "maximum": 9744.8345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8482.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3785.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6286.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5087.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8114.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6056.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3785.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6601.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8487.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9430.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6286.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8173.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8173.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6286.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3785.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6601.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6601.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6286.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9744.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5421.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3711.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6286.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7069.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7300.63 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8801.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3711.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6286.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6286.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7459.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8801.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5589.04 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14778, "minimum": 10592.84, "maximum": 24303.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24274.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 10804.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 14558.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 23220.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 17332 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 10804.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15517.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19951.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 22168.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14778.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 19212.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19212.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14778.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10804.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15517.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15517.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14778.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22907.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14143.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10592.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24303.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20891.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20690.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10592.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14778.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14778.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21347.08 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 20690.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14581.36 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5672, "minimum": 3208.78, "maximum": 8791.8325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7339.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3272.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5672.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4401.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7020.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5240.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3272.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 5955.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7657.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 8508.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5672.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7373.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7373.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5672.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3272.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5955.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5955.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5672.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 8791.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 3994.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3208.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5672.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5356.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6316.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7941.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3208.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5672.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5672.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6454.35 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 7941.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4117.68 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16169, "minimum": 9510.36, "maximum": 26860.51, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22636.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9510.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16169.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16169.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23621.03 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 22636.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17859.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26860.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9700.57, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16169.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 16109.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 25694.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 19178.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9700.57, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21828.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 24253.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 16169.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 21020.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21020.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 16169.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9700.57, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16977.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 16169.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25062.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 17323.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9510.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16169.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23366.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23116.91 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10946, "minimum": 6069.62, "maximum": 17148.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17148.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6191.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10946.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10284.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16403.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 12243.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6191.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11494.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14778.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16420.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14230.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14230.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6191.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11494.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11494.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16967.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10879.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6069.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14170.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14758.42 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15325.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6069.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10946.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15080.26 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 15325.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11216.08 } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9565, "minimum": 8744.3, "maximum": 21201.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14579.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 15142.35, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9565.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8744.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13946.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10409.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 15142.35, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10043.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12913.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 14348.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9565.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12435.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12435.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9565.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15142.35, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10043.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10043.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9565.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14826.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8787.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14845.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9565.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21201.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12547.77 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13391.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14845.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9565.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9565.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12821.4 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13391.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9059.2 } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5861, "minimum": 4613.6, "maximum": 16926.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7692.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5520.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5861.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4613.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7358.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5492.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5520.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6155.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7913.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 8792.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5861.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7620.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7620.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5861.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5520.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6155.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6155.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5861.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9086.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5230.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5412.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5861.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16926.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6620.35 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8206.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5412.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5861.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5861.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6764.72 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8206.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5392.2 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9146, "minimum": 8076.76, "maximum": 16650, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13800.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 10686.4, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8276.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13201.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 9853.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 10686.4, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9603.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12347.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13719.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9146.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11890.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11890.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9146.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10686.4, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9603.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9603.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9146.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14176.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8076.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10476.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13405.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11876.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12804.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10476.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9146.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12135.98 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12804.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8326.56 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14015, "minimum": 13159.02, "maximum": 22950, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22854.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 14195.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 13707.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 21862.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 16317.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 14195.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 14715.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18920.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 21022.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14015.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 18219.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18219.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14015.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14195.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14715.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14715.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14015.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21723.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13159.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13917.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14015.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17709.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19669.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19621.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13917.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14015, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14015.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20098.03 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 19621.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13566 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7023, "minimum": 5825.35, "maximum": 12600, "payers_information": [ { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7374.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7023.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10885.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5825.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5992.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7023.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8587.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8478.73 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9832.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5992.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7023.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7023.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8663.63 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9832.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6005.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9851.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6112.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7023.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5908.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9424.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7034.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6112.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7374.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9481.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10534.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7023.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9130.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9130.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7023.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6112.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7374.24, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31791, "minimum": 19350, "maximum": 55912.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 55912.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 20308.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31791.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 33533.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 53485.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 39921 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 20308.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 33380.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 42918.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 47687.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 31791.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 41328.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41328.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 31791.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20308.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 33380.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 33380.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 31791.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 49276.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 35945.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19909.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31791.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46620.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 48119.63 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 44507.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19909.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31791.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31791.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 49168.98 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 44507.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37057.6 } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25569, "minimum": 15773.28, "maximum": 44341.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 44341.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 16088.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25569.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 26593.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 42416.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 31659.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 16088.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 26847.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34518.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 38353.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 25569.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 33239.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 33239.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 25569.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16088.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 26847.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 26847.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 25569.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 39632.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 24932.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15773.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25569.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34031.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 38161.16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 35796.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15773.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25569.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 25569.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 38993.34 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 35796.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25703.96 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11054, "minimum": 866, "maximum": 34200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17348.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6821.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11054.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "per diem", "standard_charge_dollar": 866 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16595.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "per diem", "standard_charge_dollar": 1030 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6821.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11606.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14923.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16581.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11054.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14370.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14370.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11054.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6821.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11606.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11606.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11054.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17133.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11490.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6688.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11054.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6325.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14930.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15475.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6688.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11054.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11054.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15255.92 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 15475.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11846.12 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13225, "minimum": 866, "maximum": 21600, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21386.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13225.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "per diem", "standard_charge_dollar": 866 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 20457.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "per diem", "standard_charge_dollar": 1030 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13886.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17854.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 19838.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 13225.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 17193.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17193.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 13225.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13886.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13886.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 13225.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20499.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12942.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8234.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13225.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10075.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18405.57 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18515.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8234.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13225.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13225.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18806.94 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 18515.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13342.56 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7543, "minimum": 866, "maximum": 14850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10818.71 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4298.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7543.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "per diem", "standard_charge_dollar": 866 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10349.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "per diem", "standard_charge_dollar": 1030 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4298.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7920.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10183.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11314.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7543.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9805.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9805.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7543.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4298.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7920.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7920.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7543.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11691.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6275.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4213.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7543.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9310.89 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10560.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4213.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7543.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7543.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9513.94 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10560.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6469.88 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5790, "minimum": 866, "maximum": 9450, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7560.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2681.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5790.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "per diem", "standard_charge_dollar": 866 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7231.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "per diem", "standard_charge_dollar": 1030 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2681.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6080.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7817.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 8686.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5790.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7528, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7528, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5790.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2681.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6080.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6080.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5790.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 8975.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4215.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2628.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5790.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3315.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6506.44 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8107.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2628.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5790.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5790.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6648.33 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8107.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4345.68 } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12807, "minimum": 6185.6, "maximum": 20608.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20608.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6309.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12807.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 12359.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 19713.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14714 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6309.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13447.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17289.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 19210.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12807.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16649.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16649.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12807.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6309.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13447.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13447.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12807.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19850.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13417.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6185.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12807.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13234.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17735.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17929.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6185.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12807.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12807.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18122.6 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17929.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13832.76 } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6116, "minimum": 2474.24, "maximum": 9480.2805, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8165.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2523.72, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4897.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7811.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5830.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2523.72, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6422.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8257.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9174.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6116.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7951.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7951.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6116.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2523.72, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6422.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6422.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6116.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9480.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4896.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2474.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3796.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7027.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8562.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2474.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6116.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6116.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7180.72 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8562.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5047.92 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 80922, "minimum": 46778.6, "maximum": 157734.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 147279.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 47714.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 80922.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 88331.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 140885.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 157734.94 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 47714.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 84968.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 109245.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 121383.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 80922.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 105199.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 105199.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 80922.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 47714.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 84968.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 84968.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 80922.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 125430.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 82514.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 46778.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 80922.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 100948 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 126752.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 113291.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 46778.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 80922.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 80922.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 129516.91 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 113291.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 85066.8 } ] } ] }, { "description": "Alveoloplasty Each Quadrant", "code_information": [ { "code": "41874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6695, "discounted_cash": 3123, "minimum": 400.3459, "maximum": 6186.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4997.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5778.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4997.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1063.85 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3279.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4216.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4685.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 762.97 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4060.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4372.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1063.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3279.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3279.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4841.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4266.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1042.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4372.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1042.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4372.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4398.12 } ] } ] }, { "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": 20510, "minimum": 12448.52, "maximum": 34932.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34932.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 12697.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20510, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 20951.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 33416.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 24941.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 12697.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 21535.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27688.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 30765.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 20510.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 26663.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26663.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 20510.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12697.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 21535.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 21535.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 20510.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 31790.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 20009.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12448.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20510.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17911.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 30064.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 28714.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12448.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20510, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20510.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 30719.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 28714.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20627.92 } ] } ] }, { "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": 34159, "minimum": 21456.3, "maximum": 60315.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 60315.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 21885.43, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34159.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 36174.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 57697.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 43064.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 21885.43, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 35867.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 46114.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 51238.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 34159.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 44406.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 44406.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 34159.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21885.43, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 35867.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 35867.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 34159.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 52946.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 34280.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21456.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34159.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34012.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 51909.17 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 47822.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21456.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34159.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 34159.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 53041.16 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 47822.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35340.76 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10848, "minimum": 6030.96, "maximum": 19800, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16965.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10848.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10175.34 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16229.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 12113.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11390.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14645.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16272.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10848.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14103.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14103.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10848.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11390.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11390.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10848.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16815.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11418.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10848.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14404.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14601.27 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15187.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10848.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10848.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14919.68 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 15187.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11771.64 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16722, "minimum": 8969.12, "maximum": 27888.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27888.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 16726.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 26678.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 19912.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22574.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 25083.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 16722.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 21738.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21738.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 16722.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17558.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17558.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 16722.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25919.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 16374.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8969.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16722.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17970.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 24001.81 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 23411.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8969.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16722.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 24525.22 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 23411.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16881.12 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30015, "minimum": 19793.92, "maximum": 52609.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 52609.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 20189.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30015.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 31552.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 50325.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 37562.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 20189.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 31516.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 40520.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 45023.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 30015.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 39019.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 39019.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 30015.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20189.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 31516.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 31516.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 30015.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 46523.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 30202.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19793.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30015.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49578.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 45277.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 42021.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19793.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30015.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 30015.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 46264.58 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 42021.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31136.44 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9502, "minimum": 5451.06, "maximum": 14729.464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14463.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5560.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9502.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8674.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13835.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10326.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5560.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9978.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12828.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 14254.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9502.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12353.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12353.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9502.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5560.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9978.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9978.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9502.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14729.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 9049.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5451.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9502.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7394.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12447.57 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13304.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5451.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9502.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9502.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12719.02 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13304.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9329 } ] } ] }, { "description": "Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6556.15, "discounted_cash": 3082, "minimum": 400.3459, "maximum": 6057.8826, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1273.68 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14050, "minimum": 9703.66, "maximum": 25650, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22920.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9897.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 13746.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 21925.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 16365.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9897.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 14753.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18968.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 21075.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14050.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 18265.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18265.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14050.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9897.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14753.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14753.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14050.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21778.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14331.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9703.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13064.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19726.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19670.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9703.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14050.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20156.22 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 19670.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14774.4 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24707, "minimum": 15154.72, "maximum": 45000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 42738.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 15457.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24707.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 25632.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 40882.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 30514.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 15457.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 25942.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 33354.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 37060.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 24707.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 32119.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32119.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 24707.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15457.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 25942.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 25942.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 24707.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 38296.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 27751.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15154.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24707.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21102.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 36781.61 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 34590.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15154.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24707.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24707.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 37583.71 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 34590.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28610.2 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11071, "minimum": 6146.94, "maximum": 18900, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17381.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6269.88, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11072, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10424.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16626.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 12410.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6269.88, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11625.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14947.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16607.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11071.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14393.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14393.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11071.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6269.88, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11625.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11625.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11071.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17161.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8646.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6146.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11071.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11878.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14958.81 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15500.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6146.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11072, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11071.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15285.02 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 15500.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8914.04 } ] } ] }, { "description": "Amputation Of Toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7911.28, "discounted_cash": 3082, "minimum": 400.3459, "maximum": 7310.0227, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1122.05 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2618.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2699.88 } ] } ] }, { "description": "Amputation Thru Metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7850.66, "discounted_cash": 3082, "minimum": 400.3459, "maximum": 7254.0098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1447.36 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 } ] } ] }, { "description": "Amputation Toe & Metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8891, "discounted_cash": 3082, "minimum": 400.3459, "maximum": 8215.284, "payers_information": [ { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 853.95 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 3153.51, "10th_percentile": 3153.51, "90th_percentile": 3153.51, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10350, "minimum": 6030.96, "maximum": 16043.0425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16039.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10350.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 9619.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15343.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11452 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13972.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 15525.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10350.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 13455.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13455.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10350.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10867.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10350.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16043.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10180.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10350.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11549.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13803.91 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14490.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10350.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10350.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14104.94 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14490.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10495.6 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16853, "minimum": 10554.18, "maximum": 28132.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 28132.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 10765.26, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 16872.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 26911.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 20086.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 10765.26, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 17695.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22751.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 25279.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 16853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 21909.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21909.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 16853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10765.26, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17695.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17695.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 16853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26122.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 18711.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10554.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22579.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 24211.69 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 23594.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10554.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 24739.68 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 23594.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19290.32 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7462, "minimum": 4020.64, "maximum": 11567.092, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10669.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4101.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7462.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6398.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10206.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7617.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4101.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7835.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10074.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11193.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7462.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9701.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9701.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7462.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4101.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7835.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7835.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7462.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11567.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7351.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4020.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7462.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6342.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9182.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10447.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4020.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7462.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7462.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9382.46 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10447.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7578.72 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6350, "minimum": 3750.02, "maximum": 9843.926, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8601.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3825.02, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6350.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5158.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8228.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6141.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3825.02, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8573.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9526.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6350.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8256.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8256.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6350.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3825.02, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6668.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6350.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9843.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4925.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3750.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6350.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5674.27 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7402.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8891.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3750.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6350.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6350.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7564.38 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8891.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5077.56 } ] } ] }, { "description": "Ankle arthroscopysurgery", "code_information": [ { "code": "29892", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6213.16, "discounted_cash": 6836, "minimum": 600.5189, "maximum": 6213.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1355 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 6213.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6213.16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6213.16 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6213.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6213.16 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47050, "minimum": 12968.6, "maximum": 84288.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 84288.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 30600.16, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 47050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 50552.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 80629.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 60181.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 30600.16, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 49402.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 63517.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 70575.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 47050.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 61165.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 61165.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 47050.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 30600.16, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 49402.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 49402.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 47050.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 72928.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 51020.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30000.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47050.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12968.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 72541.21 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 65870.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30000.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 47050.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 74123.13 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 65870.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 52598.08 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29556, "minimum": 5895.15, "maximum": 51755.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 51755.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 18770.2, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29556, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 31040.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 49508.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 36953 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 18770.2, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 31033.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 39900.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 44334.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 29556.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 38422.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38422.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 29556.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18770.2, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 31033.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 31033.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 29556.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 45811.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 31524.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18402.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29556.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5895.15 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 44542.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 41378.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18402.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29556, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29556.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 45513.43 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 41378.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32499.88 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11699, "minimum": 5528.38, "maximum": 22477.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18549.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5638.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11700, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11124.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 17743.93 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5638.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12285, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15794.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 17549.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11699.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15209.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15209.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11699.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5638.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12285, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12284.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11699.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18134.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5528.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11699.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22477.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15963.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16379.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5528.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11700, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11699.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16312.07 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 16379.96, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17507, "minimum": 11018.1, "maximum": 29349.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29349.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 11238.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17507.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 17602.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 28075.41 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 11238.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 18383.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23635.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 26261.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 17507.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 22759.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22759.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 17507.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11238.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18383.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18383.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 17507.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27136.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11018.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17507.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24997.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25259.01 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 24510.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11018.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17507.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17507.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25809.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 24510.75, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9268, "minimum": 4175.28, "maximum": 14458.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14028.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4258.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8413.55 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13419.32 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4258.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9732.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12513.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13903.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9268.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12049.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12049.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9268.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4258.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9732.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9732.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9268.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14366.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4175.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14458.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12073.15 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12976.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4175.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9268.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12336.43 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12976.52, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Artery-Vein Nonautograft", "code_information": [ { "code": "36830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11750.8, "discounted_cash": 5242, "minimum": 800.6918, "maximum": 10857.7392, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 800.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9698.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1815.81 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7077.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7863.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1337.09 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6815.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1815.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8125.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 8274.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1780.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1780.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8529.92 } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11189.96, "maximum": 18000, "payers_information": [ { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11189.96 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16758.9 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11536.04 } ] } ] }, { "description": "Arthrp Ntrcrp/Crp/Mtcr Ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10998.8, "discounted_cash": 3082, "minimum": 600.5189, "maximum": 10162.8912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1642.41 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7661 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7828 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9610, "minimum": 6378.9, "maximum": 14896.988, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14664.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6506.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8795.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14027.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10470.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6506.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10091.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12974.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 14416.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9610.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12494.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12494.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9610.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6506.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10091.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10091.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9610.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14896.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8889.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6378.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11098.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12620.54 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13455.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6378.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9610.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12895.76 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13455.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9164.08 } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6161, "minimum": 3595.38, "maximum": 9550.7745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8250.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3667.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6161.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4948.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7891.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5890.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3667.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6469.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8318.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9242.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6161.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8010.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8010.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6161.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3667.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6469.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6469.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6161.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9550.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4984.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3595.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6161.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4477.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7100.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8626.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3595.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6161.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6161.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7255.08 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8626.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5138.36 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40801, "minimum": 23080.02, "maximum": 77827.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 72668.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 23541.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40801.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 43583.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 69513.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 77827.31 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 23541.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 42841.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 55082.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 61202.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 40801.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 53042.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53042.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 40801.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 23541.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 42841.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 42841.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 40801.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 63242.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 44854.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23080.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40801.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43170.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 62540.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 57122.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23080.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40801.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 40801.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 63904.38 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 57122.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46241.44 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37523, "minimum": 21147.02, "maximum": 73350, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 66572.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 21569.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37523.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 39927.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 63682.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 71298.94 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 21569.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 39400.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 50657.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 56285.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 37523.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 48781.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 48781.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 37523.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21569.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 39400.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 39400.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 37523.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 58162.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 32216.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21147.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37523.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57583.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 57294.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 52533.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21147.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37523.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 37523.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 58543.9 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 52533.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33212.76 } ] } ] }, { "description": "Av Fistula Revision Open", "code_information": [ { "code": "36832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9785, "discounted_cash": 5242, "minimum": 800.6918, "maximum": 9785, "payers_information": [ { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8125.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 8274.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1780.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1780.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9785 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8529.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 800.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9698.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1815.81 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7077.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7863.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1518.35 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6815.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1815.81 } ] } ] }, { "description": "Av Fuse Uppr Arm Basilic", "code_information": [ { "code": "36819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13034, "discounted_cash": 5242, "minimum": 600.5189, "maximum": 12043.416, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 7228.82, "10th_percentile": 7228.82, "90th_percentile": 7228.82, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9698.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1815.81 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7077.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7863.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1467.35 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6815.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1815.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8125.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 8274.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1780.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1780.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8529.92 } ] } ] }, { "description": "Av Fusion Direct Any Site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10300, "discounted_cash": 2974, "minimum": 600.5189, "maximum": 9517.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 3590.15, "10th_percentile": 3590.15, "90th_percentile": 4220.85, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1053.23 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1332.26 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1053.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4835.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1032.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1032.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4985.48 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14906, "minimum": 9201.08, "maximum": 24512.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24512.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9385.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 14701.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 23448.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 17501.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9385.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15651.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20123.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 22359.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14906.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 19378.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19378.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14906.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9385.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15651.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15651.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14906.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23105.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14738.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9201.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14906.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19153.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21096.11 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20869.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9201.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14906.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14906.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21556.16 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 20869.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15194.68 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26354, "minimum": 17203.7, "maximum": 45800.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 45800.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 17547.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 27469.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 43812.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 32701.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 17547.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 27671.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 35577.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 39531.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 26354.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 34260.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 34260.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 26354.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17547.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 27671.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 27671.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 26354.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 40848.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 27480.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17203.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26354.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28322.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 39417.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 36895.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17203.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26354, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 26354.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 40276.88 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 36895.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28330.52 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11570, "minimum": 6881.48, "maximum": 18307.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18307.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7019.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11570.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10980.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 17512.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 13071.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7019.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12148.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15619.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 17355.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11570.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15041.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15041.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11570.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7019.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12148.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12148.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11570.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17933.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10909.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6881.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11570.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15005.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15756.16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16198.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6881.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11570.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11570.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16099.76 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 16198.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11246.48 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18722, "minimum": 16391.84, "maximum": 31608.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 18957.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 30235.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 22568 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 16719.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 19658.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25274.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 28083.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 24338.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24338.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16719.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19658.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19658.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29019.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 18848.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16391.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21891.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27202.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26211.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16391.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27796.04 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 26211.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19431.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31608.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 16719.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24918, "minimum": 17203.7, "maximum": 43130.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43130.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 17547.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24918.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 25867.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 41257.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 30794.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 17547.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 26164.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 33639.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 37377.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 24918.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 32393.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32393.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 24918.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17547.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 26164.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 26163.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 24918.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 38622.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 26343.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17203.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24918.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28361 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 37119.11 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 34885.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17203.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24918.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24918.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 37928.57 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 34885.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27158.6 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18722, "minimum": 15618.64, "maximum": 31608.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31608.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 15931.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 18957.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 30235.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 22568 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 15931.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 19658.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25274.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 28083.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 24338.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24338.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15931.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19658.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19658.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29019.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 16839.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15618.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16740 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27202.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26211.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15618.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18722.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27796.04 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 26211.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17360.68 } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15401, "minimum": 866, "maximum": 25432.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25432.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2918.06, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15401.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "per diem", "standard_charge_dollar": 866 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 24328.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "per diem", "standard_charge_dollar": 1030 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2918.06, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 16171.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20792.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 23102.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 15401.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 20021.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20021.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15401.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2918.06, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16171.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16171.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15401.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23872.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10062.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2860.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15401.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10551.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21888.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21562.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2860.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15401.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15401.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22365.51 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 21562.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10374 } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9436, "minimum": 4561.88, "maximum": 17550, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14340.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4653.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9436.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8600.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13718.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10239.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4653.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9908.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12739.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 14155.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9436.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12268.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12268.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9436.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4653.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9908.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9908.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9436.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14627.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 9209.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4561.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9436.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12045.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12342.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13211.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4561.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9436.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9436.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12611.25 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13211.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9494.68 } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6483, "minimum": 2822.18, "maximum": 10800, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8848.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2878.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6483.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5306.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8464.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6317.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2878.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6807.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8752.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9725.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6483.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8428.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8428.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6483.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2878.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6807.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6807.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6483.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10049.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5688.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2822.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6483.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3348.52 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7614.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9076.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2822.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6483.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6483.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7780.99 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9076.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5864.16 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38121, "minimum": 25438.28, "maximum": 67684.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 67684.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 25947.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38121.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 40594.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 64746.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 48326.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 25947.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 40027.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 51464.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 57182.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 38121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 49558.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 49558.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 38121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 25947.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 40027.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 40027.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 38121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 59088.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 47292.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25438.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58545 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 58251.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 53370.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25438.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38121.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 38121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 59521.37 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 53370.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48755.52 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19254, "minimum": 9900, "maximum": 32598.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32598.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 12500.32, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19254.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 19551 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 31183.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 23275 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 12500.32, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 20217.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25993.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 28882.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 19254.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 25031.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25031.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 19254.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12500.32, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 20217.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 20217.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 19254.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29844.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 22009.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12255.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19254.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20423.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 28055.02 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26956.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12255.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19254.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19254.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 28666.82 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 26956.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22690.56 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16073, "minimum": 8543.86, "maximum": 26682.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26682.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8714.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16073.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 16003.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 25524.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 19051.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8714.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 16877.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21699.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 24110.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 16073.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 20895.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20895.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 16073.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8714.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16877.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16877.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 16073.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24914.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 15712.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16073.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23285.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22963.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22503.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16073.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16073.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23464.76 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 22503.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16198.64 } ] } ] }, { "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": 25222, "minimum": 13956.26, "maximum": 50128.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43696.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 14235.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25222.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 26207.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 41799.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 31199 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 14235.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 26483.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34050.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 37833.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 25222.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 32789.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32789.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 25222.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14235.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 26483.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 26483.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 25222.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 39094.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 27051.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13956.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25222.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50128.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 37606.38 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 35311.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13956.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25222.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 25222.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 38426.47 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 35311.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27888.2 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12188, "minimum": 6224.26, "maximum": 19457.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19457.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6348.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12188.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11669.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 18612.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 13892.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6348.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12797.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16454.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18282.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12188.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15844.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15844.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12188.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6348.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12797.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12797.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12188.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18891.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12515.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6224.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12188.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17816.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16745.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17063.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6224.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12188.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12188.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17110.64 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17063.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12902.52 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17931, "minimum": 11327.38, "maximum": 30137.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30137.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 11553.93, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17931.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 18075.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 28829.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 21518 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 11553.93, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 18827.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24207.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 26897.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 17931.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 23310.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23310.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 17931.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11553.93, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18827.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18827.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 17931.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27793.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 17316.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11327.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17931.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17131.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25937.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 25103.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11327.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17931.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17931.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26502.8 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 25103.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17851.64 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24491, "minimum": 15927.92, "maximum": 42336.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 42336.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 16246.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24491, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 25391.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 40498.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 30227.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 16246.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 25715.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 33062.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 36736.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 24491.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 31838.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 31838.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 24491.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16246.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 25715.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 25715.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 24491.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 37961.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 25085.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15927.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24491.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38392.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 36435.67 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 34287.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15927.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24491, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24491.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 37230.22 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 34287.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25861.28 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13975, "minimum": 8582.52, "maximum": 22780.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22780.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8754.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13975.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 13662.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 21791.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 16265.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8754.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 14674.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18866.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 20963.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 13975.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 18168.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18168.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 13975.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8754.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14674.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14674.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 13975.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21661.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13036.64 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13975.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14394.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19605.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19565.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13975.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13975.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20033.37 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 19565.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13439.84 } ] } ] }, { "description": "Biopsy of tongue", "code_information": [ { "code": "41100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5165.45, "discounted_cash": 508, "minimum": 332.89, "maximum": 4772.8758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 812.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 939.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 812.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 533.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 685.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 762.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 332.89 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 660.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 711.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 533.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 533.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 787.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 892.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 711.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 711.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 919.74 } ] } ] }, { "description": "BIOPSY OF VULVAPERINEUM", "code_information": [ { "code": "56605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8344.18, "discounted_cash": 867, "minimum": 160.59, "maximum": 7710.0223, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1388.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1605.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1388.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.64 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 911.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1171.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.59 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1128.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1214.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 265.64 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 911.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 911.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1344.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1116.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1214.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1214.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1151.2 } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38510 - OR36038510", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6695, "discounted_cash": 3688, "minimum": 333.6216, "maximum": 6695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 333.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5902.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6695, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5902.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1259.51 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3873.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4979.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 5533.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1019.36 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4795.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5164.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1259.51 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3873.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3873.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5717.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5292.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1234.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5164.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1234.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 5164.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5455.68 } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38525 - OR36038525", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9859.83, "discounted_cash": 3688, "minimum": 400.3459, "maximum": 9110.4829, "payers_information": [ { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 5533.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 869.8 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4795.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5164.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1259.51 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3873.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3873.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5717.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5292.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1234.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5164.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1234.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 5164.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5455.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5902.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6824.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5902.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1259.51 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3873.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4979.85, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "Bone biopsy open superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6719.04, "discounted_cash": 2736, "minimum": 286.9146, "maximum": 6208.393, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 286.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 301.88 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10267, "minimum": 9527.81, "maximum": 18450, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15886.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9858.3, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10268, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 9527.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15196.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11342.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9858.3, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10781.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13861.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 15401.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10267.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 13348.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13348.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10267.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9858.3, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10781.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10781.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10267.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15915.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 9774.53 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9665, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10267.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12459.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13672.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14375.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9665, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10268, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10267.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13970.23 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14375.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10076.84 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7195, "minimum": 4780.41, "maximum": 12600, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10172.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6309.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7195.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6101.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9731.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7263.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6309.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7555.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9714.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10793.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7195.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9354.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9354.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7195.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6309.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7555.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7555.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7195.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11153.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6046.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6185.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7195.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4780.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8755.06 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10074.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6185.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7195.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7195.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8945.99 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10074.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6233.52 } ] } ] }, { "description": "BONE MARROW HARVEST AUTOLOG", "code_information": [ { "code": "38232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4388.5, "discounted_cash": 4103, "minimum": 396.99, "maximum": 4388.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1979.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4103.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1573.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4308.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4103.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 396.99 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4103.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1573.25 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4308.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4308.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4103.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4388.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1542.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4103.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4103.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4388.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1542.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4103.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4103.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4388.5 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4388.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4388.5 } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15832, "minimum": 8505.2, "maximum": 27484.3, "payers_information": [ { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 22165.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16232.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26234.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8675.3, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15832.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 15734.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 25095.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 18731.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8675.3, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 16624.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21373.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 23748.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 15832.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 20582.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20582.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15832.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8675.3, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16624.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16624.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15832.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24540.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 15745.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8505.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15832.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27484.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22577.96 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22165.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8505.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15832.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15832.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23070.32 } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14438, "minimum": 7654.68, "maximum": 25997.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23641.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7807.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14438.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 14178.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 22614.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 16879.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7807.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15160.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19491.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 21657.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14438.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 18769.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18769.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14438.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7807.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15160.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15159.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14438.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22379.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13572.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7654.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14438.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25997.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20346.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20213.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7654.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14438.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14438.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20789.91 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 20213.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13992.36 } ] } ] }, { "description": "Breast Reduction", "code_information": [ { "code": "19318", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25029, "discounted_cash": 6255, "minimum": 2182.07, "maximum": 23126.796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 4615.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10009.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11573.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10009.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4035.91 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6568.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8445.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9383.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2182.07 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8132.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8758.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4035.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6568.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6568.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9696.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 9335.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3956.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7661 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8758.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3956.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7828 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 8758.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9623.76 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8125, "minimum": 4677.86, "maximum": 13050, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11902.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4771.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8125.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7138.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11385.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 8498 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4771.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8531.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10969.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12188.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8125.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10563.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10563.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8125.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4771.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8531.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8531.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8125.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12594.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6825 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4677.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8125.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6287.07 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10243.25 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11375.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4677.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8125.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8125.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10466.62 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11375.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7036.08 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6140, "minimum": 3479.4, "maximum": 9518.085, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8210.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3548.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6140.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4924.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7854.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5862.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3548.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6447.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8289.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9211.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6140.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7982.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7982.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6140.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3548.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6447.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6447.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6140.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9518.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4917.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3479.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6140.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4063.61 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7066.49 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8596.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3479.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6140.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6140.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7220.59 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8596.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5069.96 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5903, "minimum": 3402.08, "maximum": 9150.363, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7769.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3470.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4659.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7432.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5547.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3470.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6198.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7969.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 8855.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7674.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7674.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3470.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6198.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6198.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9150.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4690.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3402.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6720.25 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6686.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8264.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3402.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6832.62 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8264.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4835.88 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12018, "minimum": 8350.56, "maximum": 19814.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19141.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8517.57, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12018.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11479.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 18310.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 13666.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8517.57, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12619.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16224.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18027.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12018.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15623.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15623.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12018.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8517.57, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12619.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12619.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12018.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18628.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12077.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8350.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12018.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19814.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16473.36 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16825.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8350.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12018.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12018.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16832.6 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 16825.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12451.08 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4724, "minimum": 2435.58, "maximum": 7323.006, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5577.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2484.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4724.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 3344.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 5335.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 3982.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2484.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 4960.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6378.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 7086.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 4724.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 6141.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 6141.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 4724.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2484.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 4960.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 4960.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 4724.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 7323.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 3601.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2435.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4724.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4214.01 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4799.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 6614.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2435.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4724.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 4724.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4904.61 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 6614.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3712.6 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6573, "minimum": 3479.4, "maximum": 10350, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9016 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3548.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6573.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5407.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8624.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6437.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3548.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6902.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8874.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9860.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6573.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8545.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8545.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6573.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3548.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6902.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6902.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10350, "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": 9000, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6573.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10189.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5437.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3479.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6573.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4562.96 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7759.43 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9203.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3479.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6573.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6573.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7928.64 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9203.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5605.76 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9659, "minimum": 6997.46, "maximum": 15300, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14755.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7137.41, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9659.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8849.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14114.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10535 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7137.41, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13040.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 14489.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9659.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12557.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12557.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9659.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7137.41, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10142.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10142.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9659.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14972.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8644.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6997.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9659.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8243.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12698.59 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13523.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6997.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9659.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9659.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12975.51 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13523.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8911.76 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5456, "minimum": 2744.86, "maximum": 8456.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6937.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2799.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5456, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4160.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6636.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 4953.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2799.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7365.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 8184, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5456, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7092.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7092.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5456, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2799.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8100, "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": 9000, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5456, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 8456.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4063.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2744.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5456, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3876.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 5970.66 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7638.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2744.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5456, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5456, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6100.86 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 7638.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4189.12 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12109, "minimum": 8427.88, "maximum": 20682.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19311.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8596.44, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 17373.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 18473.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 20682.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8596.44, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16348.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18164.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12109.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15742.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15742.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12109.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8596.44, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12715.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12109.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18770.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10879.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8427.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14285.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16619.96 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16953.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8427.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12109.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16982.4 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 16953.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11216.08 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7743, "minimum": 4871.16, "maximum": 12002.2235, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11191.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4968.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7743.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10068.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10705.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11985.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4968.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8130.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10453.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11615.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7743.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10066.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10066.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7743.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4968.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8130.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8130.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7743.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12002.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6718.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4871.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7743.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7617.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9631.52 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10840.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4871.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7743.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7743.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9841.56 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10840.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6926.64 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48714, "minimum": 31082.64, "maximum": 87383.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 87383.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 31704.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48714.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 52408.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 83589.68 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 31704.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 51150.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 65764.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 73071.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 48714.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 63328.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 63328.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 48714.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 31704.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 51150.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 51150.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 48714.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 75507.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31082.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48714.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55969.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 75204.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 68200.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31082.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48714.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 48714.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 76844.32 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 68200.03, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41308, "minimum": 26211.48, "maximum": 73610.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 73610.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 26735.71, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41308.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 44148.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 70415.37 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 26735.71, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 43373.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 55766.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 61962.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 41308.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 53701.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53701.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 41308.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 26735.71, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 43373.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 43373.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 41308.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 64028.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26211.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41308.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32380.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 63351.61 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 57831.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26211.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41308.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 41308.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 64733.13 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 57831.96, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32161, "minimum": 14850, "maximum": 56599.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 56599.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 20268.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32161.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 33945.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 54142.68 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 20268.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43417.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 48241.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 32161.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 41809.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41809.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 32161.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 20268.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 33769.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 32161.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 49849.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19871.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32161.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46047.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 48711.32 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 45025.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19871.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32161.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 32161.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 49773.57 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 45025.48, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22431, "minimum": 13685.64, "maximum": 38506.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38506.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 13959.35, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22431.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 23094.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 36834.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 27493.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 13959.35, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 23553.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30282.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 33647.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 22431.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 29161.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29161.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 22431.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13959.35, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 23553.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 23553.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 22431.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 34769.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 21019.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13685.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22431.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26765 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 33139.73 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 31404.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13685.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22431.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22431.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 33862.41 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 31404.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21669.88 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15050, "minimum": 8814.48, "maximum": 24780.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24780.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8990.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15051, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 14862.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 23705.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 17693.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8990.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15803.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20318.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 22576.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 15050.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 19566.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19566.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15050.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8990.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15803.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15803.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15050.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23328.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14700.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8814.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15050.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16768.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21327.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21071.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8814.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15051, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15050.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21792.17 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 21071.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15155.16 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14183, "minimum": 8234.58, "maximum": 23842.8, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14183.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 18438.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18438.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14183.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14892.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14892.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14183.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21984.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14086.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8234.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14183.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23842.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19939.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19857.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8234.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14183.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14183.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20373.92 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 19857.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14522.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23168.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14183.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 13895.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 22162.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 16541.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 14892.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19148.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 21275.57, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23161, "minimum": 14188.22, "maximum": 50780.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39863.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 14471.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23161.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 23908.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 38132.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 28462 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 14471.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 24319.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31267.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 34741.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 23161.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 30109.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30109.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 23161.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14471.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 24319.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 24319.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 23161.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 35899.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 25791.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14188.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23161.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50780.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 34307.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 32425.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14188.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23161.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23161.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 35055.43 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 32425.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26589.36 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12466, "minimum": 7113.44, "maximum": 19974.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19974.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7255.71, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12466.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11979.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 19107.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14261.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7255.71, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13089.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16829.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18699.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12466.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16206.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16206.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12466.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7255.71, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13089.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13089.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12466.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19322.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12361.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7113.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12466.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14480.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17190.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17452.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7113.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12466.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12466.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17565.43 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17452.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12743.68 } ] } ] }, { "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": 45056, "minimum": 23400, "maximum": 80580.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 80580.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 41444.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45056.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 48328.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 77082.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 57533.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 41444.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 47309.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 60825.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 67584.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 58573.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 58573.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 41444.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 47309.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 47309.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 69837.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 46803.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 40631.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45140.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 69349.69 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 63078.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 40631.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45056.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 70862.01 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 63078.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48250.88 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 66193, "minimum": 42680.64, "maximum": 119888.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 119888.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 43534.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 66193.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 71903.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": 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"standard_charge_dollar": 66193.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 86051.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 86051.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 66193.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 43534.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 69503.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 69503.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 66193.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 102599.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 71817.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 42680.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 66193.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 98645.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 103179.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 92670.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 42680.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 66193.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 66193.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 105429.24 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 92670.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 74038.44 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45056, "minimum": 10350, "maximum": 80580.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 80580.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 39472.63, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45056.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 48328.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 77082.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 57533.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 39472.63, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 47309.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 60825.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 67584.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 58573.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 58573.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 39472.63, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 47309.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 47309.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 69837.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 43780.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 38698.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56757.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 69349.69 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 63078.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 38698.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45056.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 45056.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 70862.01 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 63078.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 45134.12 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36868, "minimum": 25200, "maximum": 65353.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36868.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 39196.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 62516.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 46662 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 26499.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 38711.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 49772.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 55302.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 36868.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 47928.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 47928.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 36868.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 26499.11, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 38711.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 38711.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 36868.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 57145.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 40067.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25979.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36868.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45049.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 56245.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 51615.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25979.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36868.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 36868.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 57471.59 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 51615.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41306.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 65353.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 26499.11, "additional_payer_notes": "102% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52324, "minimum": 33479.56, "maximum": 94097.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 94097.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 34149.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 52324.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 56435.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 90012.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 67185.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 34149.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 54941.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 70638.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 78487.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 52324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 68022.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 68022.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 52324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 34149.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 54941.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 54941.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 52324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 81103.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 59921.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33479.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65379.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 80983.03 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 73254.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33479.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 52324.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 52324.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 82749.04 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 73254.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 61775.08 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34940, "minimum": 13950, "maximum": 61767.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 61767.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 22437.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34940, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 37045.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 59086.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 44101.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 22437.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 36687, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 47169.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 52410.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 34940.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 45422.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 45422.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 34940.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 22437.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 36687, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 36687.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 34940.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 54157.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 34881.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21997.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34940.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37502.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 53158.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 48916.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21997.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34940, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 34940.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 54318.24 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 48916.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35960.16 } ] } ] }, { "description": "Care Of Miscarriage", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6643.5, "discounted_cash": 3049, "minimum": 533.7946, "maximum": 6138.594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 533.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5642, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4117.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4574.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 750.56 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3964.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4727.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4409.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4545.54 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17478, "minimum": 8550, "maximum": 29295.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29295.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 10804.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17478.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 17570.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 28023.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 20916.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 10804.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 18352.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23596.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 26218.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 17478.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 22722.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22722.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 17478.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10804.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18352.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18352.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 17478.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27091.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 16836.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10592.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17478.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23627.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25212.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 24470.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10592.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17478.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17478.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25762.42 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 24470.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17356.88 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27233, "minimum": 17126.38, "maximum": 47435.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 47435.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 17468.91, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 28449.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 45376.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 33868.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 17468.91, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 28594.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 36764.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 40849.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 27233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 35403.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35403.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 27233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17468.91, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 28594.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 28594.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 27233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 42211.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 29483.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17126.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37099.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 40824.27 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 38126.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17126.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 27233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 41714.53 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 38126.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30395.44 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14528, "minimum": 5400, "maximum": 23809.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23809.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8793.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 14279.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 22775.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 16999.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8793.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15254.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19613.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 21792.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14528.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 18886.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18886.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14528.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8793.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15254.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15254.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14528.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22518.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13864.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8621.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19344.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20490.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8621.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14528.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14528.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20937.56 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 20339.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14293.32 } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5900.96, "discounted_cash": 1839, "minimum": 547.1394, "maximum": 5452.487, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 547.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2943.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 1363.38, "10th_percentile": 1363.38, "90th_percentile": 5442.56, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 889.45, "10th_percentile": 889.45, "90th_percentile": 2668.35, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3403.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2943.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 637.98 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1931.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2483.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2759.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1839.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 850.5 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2391.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2575.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1839.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 637.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1931.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1931.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1839.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2851.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 3124.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1839.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2575.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1839.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2575.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3221 } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11091, "minimum": 8543.86, "maximum": 20700, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17418.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8714.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11091.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10446.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16661.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 12436.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8714.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11646.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14973.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16637.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11091.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14419.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14419.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11091.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8714.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11646.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11646.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11091.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17192.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10624.53 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11091.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10908.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14990.45 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15528.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11091.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11091.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15317.35 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 15528.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10953.12 } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7464, "minimum": 4871.16, "maximum": 13950, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10672.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4968.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7464.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6401.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10209.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7620.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4968.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7837.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10077.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11196.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7464.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9704.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9704.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7464.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4968.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7837.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7837.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7464.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11570.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6500.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4871.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7464.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4909.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9185.38 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10450.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4871.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7464.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7464.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9385.69 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10450.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6701.68 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21140, "minimum": 11250, "maximum": 36104.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36104.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 13170.69, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 21653.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 34537.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 25778.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 13170.69, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 22197, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28539.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 31710.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 21140.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 27482.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27482.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 21140.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13170.69, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 22197, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 22197.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 21140.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 32767.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 22639.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12912.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21140.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23699.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 31072.52 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 29596.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12912.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21140, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21140.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 31750.12 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 29596.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23339.6 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33546, "minimum": 13531, "maximum": 59175.72, "payers_information": [ { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 43610.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43610.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 33546.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13801.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 35223.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 35223.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 33546.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 51996.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 37132.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13531, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33546.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37861.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 50928.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 46964.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13531, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33546.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33546.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 52038.9 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 46964.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38281.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 59175.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 13801.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33546.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 35490.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 56606.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 42251.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 13801.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 35223.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 45287.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 50319.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 33546.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17813, "minimum": 7200, "maximum": 29918.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29918.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 12539.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17813.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 17943.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 28619.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 21361.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 12539.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 18704.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24048.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 26720.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 17813.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 23157.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23157.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 17813.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12539.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18704.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18704.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 17813.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27610.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 18688.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12293.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17813.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20249.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25748.39 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 24938.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12293.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17813.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17813.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26309.89 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 24938.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19266.76 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8711, "minimum": 5329, "maximum": 13950, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12991.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5441.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8711.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5329 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9521 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6344 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5441.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9147, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11760.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13067.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8711.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11324.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11324.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "case rate", "standard_charge_dollar": 9578 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8711.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5441.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9147, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9147, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8711.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13502.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7696.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5335.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8711.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7893.43 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11180.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12196, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5335.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8711.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8711.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7092 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12196, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7934.4 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17904, "minimum": 5329, "maximum": 30087.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30087.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5717.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17904.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5329 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9521 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6344 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5717.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 18799.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24170.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 26856.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 17904.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 23275.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23275.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "case rate", "standard_charge_dollar": 9578 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 17904.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5717.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18799.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18799.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 17904.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27751.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14225.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5605.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17904.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12510.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25893.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 6639, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5605.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17904.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17904.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7092 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 25066.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14665.72 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8037, "minimum": 5064.46, "maximum": 12457.784, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11737.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5165.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5329 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9521 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6344 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5165.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8439.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10850.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12055.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8037.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10448.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10448.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "case rate", "standard_charge_dollar": 9578 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8037.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5165.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8439.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8439.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8037.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12457.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6724 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5064.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6549.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10101.92 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11252.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5064.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8037.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7092 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11252.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6931.96 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9085, "minimum": 4561.88, "maximum": 14850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13686.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4653.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9085.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5329 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9521 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6344 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4653.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9539.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12264.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13627.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9085.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11810.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11810.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "case rate", "standard_charge_dollar": 9578 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9085.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4653.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9539.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9539.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9085.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14081.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7853.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4561.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9085.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11683.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11778.89 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12719.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4561.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9085.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9085.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7092 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12719.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8096.28 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12595, "minimum": 4793.84, "maximum": 20214.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20214.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4889.72, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12595.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5329 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9521 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6344 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4889.72, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13225.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17003.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18893.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12595.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16374.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16374.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "case rate", "standard_charge_dollar": 9578 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12595.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4889.72, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13225.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13225.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12595.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19523.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11905.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4793.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12595.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17397.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17633.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4793.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12595.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12595.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7092 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17633.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12274 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8043, "minimum": 4368.58, "maximum": 13050, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11750.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4455.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8043.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5329 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9521 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6344 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4455.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8446.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10859.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12065.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8043.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10457.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10457.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "case rate", "standard_charge_dollar": 9578 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8043.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4455.95, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8446.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8446.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8043.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12468, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6431.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4368.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8043.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8538.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10112.46 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 6639, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4368.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8043.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8043.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7092 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11261.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6630.24 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33385, "minimum": 9896.96, "maximum": 63056.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 58876.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 10094.9, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33385.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 52967.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 56320.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 63056.44 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 10094.9, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 35054.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 45070.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 50078.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 33385.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 43401.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43401.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 33385.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10094.9, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 35054.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 35054.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 33385.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 51747.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 39677.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9896.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33385.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43729.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 50670.95 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 46739.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9896.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33385.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33385.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 51775.94 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 46739.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40904.72 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15481, "minimum": 9433.04, "maximum": 27397.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25581.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9621.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15481.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 23013.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 24470.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 27397.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9621.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 16255.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20899.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 23221.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 15481.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 20125.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20125.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15481.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9621.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16255.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16255.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15481.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23995.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 16396.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9433.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15481.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13364 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22015.81 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21673.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9433.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15481.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15481.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22495.91 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 21673.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16903.16 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11240, "minimum": 8839.72, "maximum": 18951.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17694.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11240.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 15919 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16926.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 18951.19 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11802.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15174.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16860.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11240.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14612.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14612.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11240.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11802.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11802.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": 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15736.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10447.72 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10346, "minimum": 5683.02, "maximum": 17550, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16031.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5796.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 9615.27 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15336.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11446.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5796.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10863.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13967.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", 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"methodology": "case rate", "standard_charge_dollar": 5796.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10863.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10863.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10346.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16036.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8979.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5683.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7767.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13797.59 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14484.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5683.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10346.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10346.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14098.47 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14484.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9257.56 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], 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"payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9661.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 19750.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25393.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 28214.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 18809.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 24452.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24452.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 18809.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9661.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19750.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19750.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 18809.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29155.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 17759.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9471.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18809.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13402.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27343.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26333.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9471.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18809.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18809.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27939.37 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 26333.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18308.4 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7322, "minimum": 3092.8, "maximum": 12150, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10409.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3154.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7322.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6243.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9957.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7432.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3154.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7689.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9885.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10984.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7322.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9519.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9519.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": 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"case rate", "standard_charge_dollar": 10252.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3092.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7322.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7322.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9153.98 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10252.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7061.16 } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6470, "minimum": 3827.34, "maximum": 10028.7945, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8823.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3903.89, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6470.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5292 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case 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Medicare", "methodology": "case rate", "standard_charge_dollar": 6793.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6793.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6470.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10028.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5332.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3827.34, "additional_payer_notes": 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"payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6470.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7759.44 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9058.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5497.84 } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 286297, "minimum": 55350, "maximum": 529205.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case 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"standard_charge_dollar": 372186.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 286297.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 171416.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 300611.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 300612.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": 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TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15344.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8241.54, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16112.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16112.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15344.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23784.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14744 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8079.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15344.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19297 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21797.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21482.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8079.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15344.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15344.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22272.83 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 21482.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15200 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25202, "minimum": 13956.26, "maximum": 43659.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43659.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 14235.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25202.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 26185.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 41764.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 31172.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 14235.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 26462.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34023.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 37804.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 25202.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 32763.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32763.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 25202.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14235.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 26462.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 26462.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 25202.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 39064.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 26057.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13956.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25202.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33426.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 37574.74 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 35283.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13956.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25202.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 25202.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 38394.14 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 35283.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26863.72 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10709, "minimum": 5335.08, "maximum": 19527.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16707.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5441.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10020.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15981.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11928.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5441.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14457.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16064.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 13922.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13922.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5441.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11244.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11244.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16599.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10146.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5335.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19527.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14378.73 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14993.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5335.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14692.28 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14993.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10460.64 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15580, "minimum": 8234.58, "maximum": 25766.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25766.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15580.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 15453.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 24647.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 18396.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 16359.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21034.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 23371.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 15580.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 20255.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20255.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15580.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16359.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16359.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15580.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24150.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 16923.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8234.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15580.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20336.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22175.07 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21813.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8234.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15580.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15580.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22658.64 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 21813.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17447.32 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23493, "minimum": 12951.1, "maximum": 40481.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 40481.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 13210.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23494, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 24279.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 38724.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 28903.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 13210.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 24668.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31716.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 35240.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 23493.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 30542.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30542.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 23493.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13210.12, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 24668.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 24668.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 23493.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 36415.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 24904.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12951.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23493.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26105.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 34839.91 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 32891.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12951.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23494, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23493.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 35599.66 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 32891.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25674.32 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12668, "minimum": 6494.88, "maximum": 20349.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20349.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6624.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12668, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 12204.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 19466.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14529.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6624.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13301.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17101.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 19002.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12668.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16468.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16468.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12668.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6624.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13301.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13301.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12668.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19635.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11945.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6494.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12668.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15860.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17513.29 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17735.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6494.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12668, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12668.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17895.21 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17735.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12315.04 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7280, "minimum": 3943.32, "maximum": 12150, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10330.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4022.19, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7280.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6196.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9882.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7376.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4022.19, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7644.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9829.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10921.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7280.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9464.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9464.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7280.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4022.19, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7644.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7644.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7280.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11285.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6370.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3943.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7280.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6905.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8891.12 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10193.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3943.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7280.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7280.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9085.01 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10193.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6567.92 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9025, "minimum": 6185.6, "maximum": 15300, "payers_information": [ { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12183.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13537.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9025.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11732.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11732.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9025.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6309.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9476.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9476.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9025.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13988.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8002.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6185.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9025.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7761.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11682.91 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12635.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6185.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9025.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9025.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11937.68 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12635.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8249.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13574.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6309.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9025.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8141.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12985.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 9692.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6309.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9476.37, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5956, "minimum": 3015.48, "maximum": 9450, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7867.71 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3075.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5956.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4718.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7526.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5617.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3075.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6253.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8040.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 8934.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5956.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7743.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7743.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5956.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3075.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6253.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6253.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5956.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9232.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4807.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3015.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5956.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4303.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6771.17 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8338.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3015.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5956.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5956.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6918.83 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8338.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4955.96 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16307, "minimum": 10244.9, "maximum": 27117.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27117.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 10449.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16307.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 16264.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 25940.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 19362 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 10449.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 17123.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22015.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 24461.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 16307.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 21199.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21199.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 16307.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10449.8, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17123.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17123.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 24300, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 31500, "10th_percentile": 31500, "90th_percentile": 31500, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 16307.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25276.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 15636.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10244.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16307.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17519.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23338.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22830.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10244.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16307.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16307.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23847.35 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 22830.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16119.6 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8777, "minimum": 6108.28, "maximum": 13604.8615, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13114.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6230.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7865.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12544.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 9363.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6230.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9216.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11849.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13166, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11410.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11410.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6230.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9216.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9216.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13604.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8110.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6108.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10417.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11286.34 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12288.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6108.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8777.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11532.47 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12288.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8361.52 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8685, "minimum": 5605.7, "maximum": 14850, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12943.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5717.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7763.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12381.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 9241.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5717.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9120.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11725.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13028.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8685.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11291.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11291.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8685.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5717.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9120.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9120.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8685.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13462.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7665.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5605.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8674.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11139.74 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12160.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5605.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8685.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11382.67 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12160.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7902.48 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14695, "minimum": 8389.22, "maximum": 24120.29, "payers_information": [ { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21211.29 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 20574.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14350.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24120.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8557, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 14466.27 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 23073.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 17221.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8557, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19839.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 22043.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14695.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 19104.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19104.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14695.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8557, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15430.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14695.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22778.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13919.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8389.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14695.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17026.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20758.61 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20574.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8389.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14695.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6420, "minimum": 3672.7, "maximum": 9952.1935, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8731.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3746.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6420.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5236.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8352.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6234.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3746.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6741.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8668.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9631.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6420.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8347, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8347, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6420.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3746.15, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6741.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6741.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6420.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9952.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4627.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6420.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5713.81 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7514.74 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8989.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6420.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6420.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7678.61 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8989.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4770.52 } ] } ] }, { "description": "Claviculectomy Partial", "code_information": [ { "code": "23120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8755, "discounted_cash": 3082, "minimum": 667.2432, "maximum": 8089.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 667.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1157.89 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 } ] } ] }, { "description": "Cltx Dst Rdl Fx/Ephys Sep W/", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7850.66, "discounted_cash": 1514, "minimum": 400.3459, "maximum": 7254.0098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2423.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2802.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2423.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 531.06 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1590.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2045.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2272.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1071.05 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2120.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.06 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1590.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1590.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2348.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2618.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 520.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2120.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 520.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2120.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2699.88 } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11777, "minimum": 8234.58, "maximum": 18692.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18692.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11210.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 17881.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 13346.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15899.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 17665.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11777.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15310.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15310.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11777.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8399.27, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12365.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11777.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18254.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11537.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8234.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11777.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10752.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16087.34 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16487.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8234.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11777.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11777.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16438.16 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 16487.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11894.76 } ] } ] }, { "description": "Colonoscopy W/Band Ligation", "code_information": [ { "code": "45398", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7850.66, "discounted_cash": 1127, "minimum": 306.456, "maximum": 7254.0098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 717.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1127.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1803.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2085.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1803.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.3 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1183.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1521.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1691.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1127.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1343.98 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1465.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1578.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1127.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 570.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1183.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1183.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1127.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1747.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1816.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 559.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1127.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1127.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1578.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 559.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1127.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1127.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1578.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1872.78 } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC", "code_information": [ { "code": "454", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44902.11, "maximum": 46290.84, "payers_information": [ { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 44902.11 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46290.84 } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC", "code_information": [ { "code": "453", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 67489.19, "maximum": 69576.48, "payers_information": [ { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 67489.19 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 69576.48 } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "455", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35297.14, "maximum": 36388.8, "payers_information": [ { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 35297.14 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36388.8 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8865, "minimum": 6069.62, "maximum": 14400, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13278.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6191.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8865.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7963.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12701.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 9480.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6191.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9308.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11968.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13298.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8865.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11525.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11525.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8865.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6191.01, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9308.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9308.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 14400, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8865.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13741.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7781.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6069.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8865.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8629.14 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11427.67 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12411.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6069.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8865.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8865.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11676.88 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12411.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8021.8 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14656, "minimum": 11018.1, "maximum": 24046.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24046.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 11238.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14656.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 14422.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 23002.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 17169.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 11238.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15389.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19785.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 21984.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14656.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 19053.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19053.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14656.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11238.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15389.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15389.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14656.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22717.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14037.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11018.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14656.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12866.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20695.32 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20518.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11018.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14656.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14656.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21146.63 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 20518.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14471.16 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7001, "minimum": 4484.56, "maximum": 10852.077, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9811.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4574.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7001.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5884.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9385.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7005.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4574.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7351.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9451.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10502.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7001.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9101.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9101.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7001.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4574.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7351.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7351.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7001.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10852.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5674.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4484.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7001.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5095.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8443.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9801.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4484.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7001.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7001.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8628.07 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9801.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5850.48 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8330, "minimum": 3711.36, "maximum": 13050, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12283.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3785.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7366.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11749.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 8770.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3785.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8747.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11246.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12495.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8330.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10829.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10829.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8330.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3785.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8747.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8747.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8330.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12912.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7532.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3711.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7098.42 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10571.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11662.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3711.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8330.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10801.79 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11662.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7765.68 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13790, "minimum": 6765.5, "maximum": 22436.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22436.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6900.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 13456.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 21462.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 16019.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6900.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 14479.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18616.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 20685.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 13790.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 17927.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17927.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 13790.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6900.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14479.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14479.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 13790.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21374.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13222.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6765.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13790.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12255.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19309.45 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19306.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6765.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13790.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19730.53 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 19306.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13631.36 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6261, "minimum": 2551.56, "maximum": 9706.0225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8436.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2602.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6261.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5059.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8070.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6023.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2602.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6575.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8453.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9392.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6261.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8140.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8140.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6261.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2602.59, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6575.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6575.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6261.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9706.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5366.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2551.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6261.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5166.32 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7260.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8766.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2551.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6261.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6261.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7418.89 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8766.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5532.04 } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 73385, "minimum": 47435.82, "maximum": 133262.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 133262.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 48384.54, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 73385.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 79924.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 127477.07 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 48384.54, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 77054.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 99069.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 110077.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 73385.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 95400.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 95400.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 73385.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 48384.54, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 77054.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 77054.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 73385.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 113746.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 47435.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 73385.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 103930 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 114689.13 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 102739.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 47435.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 73385.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 73385.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 117190.18 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 102739.07, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8965, "minimum": 6030.96, "maximum": 13895.967, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13463.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8074.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12878.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 9612.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9413.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12102.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13447.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11654.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11654.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9413.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9413.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13895.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8608.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13074.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11586.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12551.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11839.61 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12551.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8874.52 } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10633, "minimum": 7422.72, "maximum": 16566.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16566.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7571.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10633.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 9935.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15847.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11828.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7571.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11165.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14355.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 15950.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10633.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 13823.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13823.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10633.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7571.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11165.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11165.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10633.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16482.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11620.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7422.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10633.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13458.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14257.43 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14887.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7422.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10633.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10633.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14568.35 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14887.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11979.88 } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7150, "minimum": 4523.22, "maximum": 11082.934, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10088.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4613.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6050.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9650.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7203 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7507.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9652.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10725.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7150.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9295.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9295.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7150.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4613.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7507.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7507.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7150.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11082.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6067.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4523.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10710.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8682.29 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10010.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4523.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7150.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8871.63 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10010.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6255.56 } ] } ] }, { "description": "Conization Of Cervix", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6624.48, "discounted_cash": 3049, "minimum": 286.09, "maximum": 6121.0195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 503.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 4726.38, "10th_percentile": 4726.38, "90th_percentile": 4726.38, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 3153.51, "10th_percentile": 3153.51, "90th_percentile": 3153.51, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5642, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4117.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4574.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 514.85 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3964.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Early Detection Works", "plan_name": "Early Detection Works Program", "methodology": "fee schedule", "standard_charge_dollar": 286.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4727.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4409.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4545.54 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9326, "minimum": 8477.49, "maximum": 15300, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12164.91 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13056.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8621.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9326.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12430.19 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13056.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9162.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14134.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8793.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8477.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13521.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10092.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8793.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9792.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12590.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13989.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9326.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12124.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12124.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9326.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8793.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9792.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9792.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9326.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14455.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8887.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8621.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10801.9 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18079, "minimum": 18079.68, "maximum": 30413.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30413.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 18888.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18079.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 18240.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 29092.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 21714.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 18888.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 18983.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24407.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 27119.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 18079.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 23503.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23503.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 18079.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18888.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18983.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18983.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 18079.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28023.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 18493.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18518.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18079.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20832.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26174.49 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 25311.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18518.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18079.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18079.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26745.28 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 25311.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19065.36 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7235, "minimum": 2628.88, "maximum": 11215.707, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10247.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2681.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6146.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9802.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7316.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2681.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7597.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9768.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10853.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9406.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9406.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2681.46, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7597.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7597.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11215.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6743.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2628.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6945.43 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8819.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10130.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2628.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7235.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9011.73 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10130.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6952.48 } ] } ] }, { "description": "Cor Hlx Vlgs Double Osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13985.8, "discounted_cash": 6836, "minimum": 2007.01, "maximum": 12922.8792, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 6738.13, "10th_percentile": 6738.13, "90th_percentile": 8216.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 5482.25, "10th_percentile": 5482.25, "90th_percentile": 5482.25, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12646.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9228.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10254.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2007.01 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8887.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10596.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 } ] } ] }, { "description": "Cor Hlx Vlgs Dstl Mtar Osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11473, "discounted_cash": 3082, "minimum": 333.6216, "maximum": 10601.052, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 333.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 8216.65, "10th_percentile": 8216.65, "90th_percentile": 8216.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1816.09 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 } ] } ] }, { "description": "Cor Hlx Vlgs Jt Arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11988.2, "discounted_cash": 12095, "minimum": 390.7607, "maximum": 11988.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 390.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2083.51 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10876.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 11988.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11212.84 } ] } ] }, { "description": "Cor hlx vlgs prx phlx osteot", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5127.32, "discounted_cash": 6836, "minimum": 377.8008, "maximum": 5127.32, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1700.99 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5127.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 5127.32 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 5127.32 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5127.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 377.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 7501.91, "10th_percentile": 6107.95, "90th_percentile": 8216.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 5127.32, "additional_payer_notes": "150.00% 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": 52106, "minimum": 29536.24, "maximum": 93691.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 93691.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 30126.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 52106.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 56192.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 89624.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 66895.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 30126.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 54712.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 70344.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 78160.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 52106.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 67738.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 67738.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 52106.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 30126.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 54712.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 54712.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 52106.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 80765.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 57095.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29536.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52106.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67447.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 80633.92 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 72949.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29536.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 52106.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 52106.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 82392.32 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 72949.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 58861.24 } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37724, "minimum": 24665.08, "maximum": 66945.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 66945.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 25158.38, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37724.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 40150.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 64039.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 47798.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 25158.38, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 39610.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 50927.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 56586.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 37724.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 49041.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 49041.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 37724.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 25158.38, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 39610.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 39610.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 37724.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 58472.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 38233.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24665.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37724.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55320.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 57615.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 52813.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24665.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37724.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 37724.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 58871.52 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 52813.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39415.88 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 57277, "minimum": 36765.66, "maximum": 103308.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 103308.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 37500.97, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 57277.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 61959.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 98823.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 73761.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 37500.97, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 60141.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 77325.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 85916.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 57277.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 74461.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 74461.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 57277.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 37500.97, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 60141.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 60141.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 57277.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 88780.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 61874.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36765.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 57277.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50918 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 88910.16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 80189.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 36765.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 57277.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 57277.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 90849.03 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 80189.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 63788.32 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41677, "minimum": 26443.44, "maximum": 74297.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 74297.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 26972.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41677.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 44560.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 71071.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 53047.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 26972.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 43761.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 56264.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 62516.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 41677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 54180.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 54180.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 41677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 26972.31, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 43761.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 43761.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 41677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 64600.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 43183.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26443.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58278.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 63942.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 58348.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26443.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41677.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 41677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 65336.64 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 58348.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 44519.28 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40399, "minimum": 18092.88, "maximum": 71919.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 71919.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 18454.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40399.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 43134.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 68797.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 51350.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 18454.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 42419.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 54538.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 60598.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 40399.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 52518.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 52518.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 40399.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18454.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 42419.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 42419.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 40399.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 62618.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 44158.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18092.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40399.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51976 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 61896.12 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 56558.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18092.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40399.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 40399.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 63245.9 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 56558.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 45524 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29329, "minimum": 17242.36, "maximum": 51333.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 51333.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 17587.21, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 30787.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 49105.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 36652 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 17587.21, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 30795.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 39594.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 43994.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 29329.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 38128.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38128.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 29329.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17587.21, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 30795.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 30795.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 29329.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 45460.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 30065.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17242.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29329.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42007.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 44179.27 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 41061.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17242.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29329.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 45142.7 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 41061.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30995.84 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30242, "minimum": 14922.76, "maximum": 53032.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 53032.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 15221.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30242.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 31806.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 50730.11 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 15221.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 31754.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 40827.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 45364.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 30242.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 39315.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 39315.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 30242.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15221.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 31754.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 31754.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 30242.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 46876.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14922.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30242.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45457.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 45641.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 42339.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14922.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30242.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 30242.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 46636.39 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 42339.82, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22490, "minimum": 10350, "maximum": 38615.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38615.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 14511.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22490.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 23159.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 36939.17 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 14511.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 23614.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30361.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 33735.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 22490.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 29237.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29237.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 22490.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14511.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 23614.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 23614.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 22490.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 34860.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14226.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22490.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34265.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 33233.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 31486.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14226.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22490.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22490.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 33958.33 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 31486.46, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22881, "minimum": 12150, "maximum": 39343.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39343.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 13801.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22881.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 23596.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 37635.52 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 13801.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 24025.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30890.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 34322.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 22881.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 29746.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29746.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 22881.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13801.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 24025.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 24025.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 22881.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 35466.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13531, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22881.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27304.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 33860.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 32034.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13531, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22881.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22881.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 34598.48 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 32034.48, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12297, "minimum": 8814.48, "maximum": 19660.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19660.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8990.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11791.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 18807.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14037.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8990.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12912.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16601.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18446.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12297.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15986.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15986.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12297.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8990.77, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12912.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12912.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 17550, "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": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12297.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19061.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11052.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8814.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12297.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12933.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16920.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17216.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8814.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12297.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12297.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17289.54 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17216.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11394.68 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518, "minimum": 5683.02, "maximum": 13203.4425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12632.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5796.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8518.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7576.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12084.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 9019.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5796.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8944.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11499.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12777.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8518.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11073.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11073.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8518.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5796.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8944.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8944.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 12600, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8518.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13203.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7545.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5683.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8518.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8053.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10871.85 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11925.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5683.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8518.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8518.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11108.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11925.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7779.36 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22214, "minimum": 12796.46, "maximum": 38103.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38103.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 13052.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22214.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 22852.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 36449.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 27205.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 13052.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 23325.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29990.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 33322.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 22214.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 28879.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28879.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 22214.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13052.39, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 23325.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 23325.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 22214.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 34433.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 22289.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12796.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22214.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24410.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 32792.73 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 31100.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12796.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22214.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22214.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 33507.85 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 31100.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22978.6 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31687, "minimum": 21417.64, "maximum": 55719.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 55719.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 21845.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 33418.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 53300.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 39783.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 21845.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 33272.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 42778.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 47531.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 31687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 41194.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41194.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 31687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21845.99, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 33272.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 33272.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 31687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 49116.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 33472.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21417.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36720.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 47954.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 44363.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21417.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 48999.79 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 44363.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34507.8 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18351, "minimum": 7200, "maximum": 30918.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30918.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 11396.19, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 18543.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 29575.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 22075.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 11396.19, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 19268.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24774.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 27526.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 18351.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 23856.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23856.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 18351.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11396.19, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19268.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19268.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 18351.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28444.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 18396.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11172.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18351.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24370.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26609.03 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 25691.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11172.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18351.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 27189.29 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 25691.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18965.04 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46082, "minimum": 15000.08, "maximum": 86032.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 82489.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 15300.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46082.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 49473.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 78908.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 58897.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 48387.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 62211.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 69124.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 46082.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 59907.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 59907.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 46082.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15300.08, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 48387.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 48387.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 46082.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 71428.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 49657.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15000.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46082.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 86032.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 70992.91 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 64516.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15000.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 46082.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 46082.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 72541.06 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 64516.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51193.6 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39487, "minimum": 24239.82, "maximum": 70224.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 70224.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 24724.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 42117.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 67176.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 50140.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 24724.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 41462.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 53308.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 59231.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 39487.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 51334.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 51334.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 39487.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 24724.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 41462.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 41462.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 39487.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 61206.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 42251.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24239.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39487.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54400.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 60437.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 55282.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24239.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 39487.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 61755.44 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 55282.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43558.64 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27504, "minimum": 17319.68, "maximum": 47940.33, "payers_information": [ { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 28879.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 27504.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 42632.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 29110.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17319.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27504.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33504.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 41258.81 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 38506.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17319.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27504.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 27504.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 42158.55 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 38506.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30010.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 47940.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 17666.07, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27504.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 28752.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 45859.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 34229.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 17666.07, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 28879.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 37131.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 41256.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 27504.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 35755.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35755.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 27504.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17666.07, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 28879.83, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Create Eardrum Opening", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 1461, "minimum": 311.53, "maximum": 5234.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 356.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1461.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2338.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2704.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2338.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.92 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1534.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1973.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2192.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1461.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 311.53 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1900.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2046.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1461.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 503.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1534.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1534.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1461.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2265.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2208.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1461.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1461.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2046.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1461.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1461.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2046.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2276.36 } ] } ] }, { "description": "Cysto impl 4 or more", "code_information": [ { "code": "C9740", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2940.33, "discounted_cash": 8918, "minimum": 882.099, "maximum": 2940.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2940.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2940.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2940.33 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2940.33, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10886.3, "discounted_cash": 5051, "minimum": 832.58, "maximum": 10058.9412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 2866.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8082.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9345.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8082.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2278.37 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5303.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6819.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7577.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 832.58 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6566.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7071.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2278.37 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5303.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5303.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7829.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 7189.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2233.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7661 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7071.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2233.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7828 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7071.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7412.06 } ] } ] }, { "description": "Cystoscopy And Treatment - 52234 - OR36052234", "code_information": [ { "code": "52234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8755, "discounted_cash": 3320, "minimum": 467.0702, "maximum": 8089.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 467.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5313.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6143.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5313.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.93 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3486.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4483.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4981.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 492.8 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4317.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4649.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1151.93 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3486.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3486.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5147.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5231.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1129.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4649.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1129.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4649.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5393.52 } ] } ] }, { "description": "Cystoscopy And Treatment - 52235 - OR36052235", "code_information": [ { "code": "52235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7622, "discounted_cash": 3320, "minimum": 500.4324, "maximum": 7042.728, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 500.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5313.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6143.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5313.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.93 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3486.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4483.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4981.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 577.57 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4317.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4649.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1151.93 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3486.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3486.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5147.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5231.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1129.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4649.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1129.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4649.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5393.52 } ] } ] }, { "description": "Cystoscopy And Treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5749.98, "discounted_cash": 1969, "minimum": 467.0702, "maximum": 5312.9815, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 484.52 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2560.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 673.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3052.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 3289.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 659.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 659.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3391.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 467.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3150.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3643.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3150.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.02 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2658.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2954.06, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5534.56, "discounted_cash": 3320, "minimum": 467.0702, "maximum": 5534.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 467.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5313.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 2668.35, "10th_percentile": 2668.35, "90th_percentile": 2668.35, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 2668.35, "10th_percentile": 2668.35, "90th_percentile": 2668.35, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5534.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5313.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.93 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3486.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4483.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4981.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 972.49 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4317.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4649.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1151.93 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3486.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3486.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5147.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5231.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1129.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4649.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1129.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3320.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4649.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5393.52 } ] } ] }, { "description": "CYSTOSCOPY WBIOPSY(S)", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6003.61, "discounted_cash": 1969, "minimum": 467.0702, "maximum": 5547.3356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 467.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3150.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3643.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3150.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.02 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2658.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2954.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 733.33 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2560.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 673.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3052.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 3289.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 659.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 659.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3391.36 } ] } ] }, { "description": "Cystouretero W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8746.97, "discounted_cash": 5051, "minimum": 784.33, "maximum": 8746.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 800.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8082.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8746.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8082.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5303.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6819.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7577.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 784.33 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6566.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7071.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1709.75 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5303.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5303.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7829.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 7189.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1676.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7661 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7071.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1676.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5051.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7828 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7071.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7412.06 } ] } ] }, { "description": "CYSTOURETERO WSTONE REMOVE", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1944.98, "discounted_cash": 3320, "minimum": 533.7946, "maximum": 1944.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1944.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 533.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.93 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 709.89 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1151.93 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1944.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1129.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1944.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1129.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1944.98 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1944.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1944.98 } ] } ] }, { "description": "CYSTOURETHRO WADDL IMPLANT", "code_information": [ { "code": "52442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2940.33, "minimum": 611, "maximum": 2716.8649, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1888.46 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 } ] } ] }, { "description": "CYSTOURETHRO WIMPLANT", "code_information": [ { "code": "52441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5880.67, "minimum": 611, "maximum": 5433.7391, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2465.34 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7850.66, "discounted_cash": 656, "minimum": 326, "maximum": 7254.0098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1051.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 2668.35, "10th_percentile": 2668.35, "90th_percentile": 2668.35, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1215.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1051.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.06 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 689.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 886.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 985.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 326 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 854.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 919.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 350.06 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 689.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 689.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1018.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1097.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 919.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 919.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1131.2 } ] } ] }, { "description": "D & C AFTER DELIVERY", "code_information": [ { "code": "59160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2121.8, "discounted_cash": 3049, "minimum": 404.57, "maximum": 2121.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2121.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 533.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.57 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2121.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2121.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2121.8 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2121.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2121.8 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15228, "minimum": 8350.56, "maximum": 25111.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25111.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8517.57, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15228.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 15060.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 24021.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 17929.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8517.57, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15990.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20558.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 22843.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 15228.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 19797.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19797.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15228.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8517.57, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15990.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15990.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15228.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23604.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13994.27 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8350.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15228.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13101.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21611.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21320.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8350.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15228.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15228.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22083.15 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 21320.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14427.08 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9221, "minimum": 3738.72, "maximum": 14293.3095, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13940.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4731.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9221.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8360.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13334.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 9953.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4731.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9682.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12449.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13832.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9221.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11987.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11987.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9221.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4731.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9682.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9682.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9221.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14293.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8483.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4639.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9221.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3738.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11997.21 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12910.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4639.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9221.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9221.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12258.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12910.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8746.08 } ] } ] }, { "description": "Dbrdmt Musc&/Fsca 1St 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6757.83, "discounted_cash": 696, "minimum": 228.8, "maximum": 6244.2349, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1114.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1288.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1114.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 939.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1044.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 450.06 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 905.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 974.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 731.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 947.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 974.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 974.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 976.4 } ] } ] }, { "description": "Dbrdmt Subq Tis 1St 20Sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7178.76, "discounted_cash": 382, "minimum": 230.89, "maximum": 6633.1742, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 612.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 708.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 612.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 574.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 230.89 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 497.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 593.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 602.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 536.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 536.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 621.6 } ] } ] }, { "description": "Deb skin bone at fx site", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5150, "discounted_cash": 2736, "minimum": 1395.68, "maximum": 5062.636, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 2016.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1763.36 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1395.68 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1763.36 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1728.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1728.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Decompress Spinal Cord Lmbr", "code_information": [ { "code": "63056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17504.8, "discounted_cash": 6836, "minimum": 400.3459, "maximum": 16174.4352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5440 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12646.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9228.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10254.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2979.5 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8887.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10596.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10876.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11212.84 } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8510.97, "maximum": 15300, "payers_information": [ { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8510.97 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11715.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8774.2 } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6529.38, "maximum": 10800, "payers_information": [ { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6529.38 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7535.03 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6731.32 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17034, "minimum": 15464, "maximum": 28469.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 28469.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 15773.28, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17034.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 17074.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 27233.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 20327.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 15773.28, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 17886.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22996.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 25551.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 17034.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 22144.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22144.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 17034.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15773.28, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17886.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17886.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 17034.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26403.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 16445.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15464, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17034.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20795.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 24501.74 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 23848.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15464, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17034.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17034.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25036.05 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 23848.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16954.08 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10263, "minimum": 9471.7, "maximum": 17100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15877.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9661.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 9522.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15188.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11336.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9661.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10776.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13855.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 15395.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10263.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 13342.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13342.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10263.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9661.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10776.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10776.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10263.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15908.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 9594.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9471.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13887.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13664.69 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14368.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9471.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10263.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10263.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13962.68 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14368.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9891.4 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7720, "minimum": 3208.78, "maximum": 12600, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11149.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3272.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7720.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6687.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10665.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7960.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3272.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8107.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10423.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11581.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7720.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10037.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10037.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7720.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3272.96, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8107.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8107.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7720.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11967.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6849.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3208.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7720.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7053.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9595.66 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10809.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3208.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7720.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7720.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9804.91 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10809.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7061.16 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13039, "minimum": 6108.28, "maximum": 21039.38, "payers_information": [ { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12324.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6108.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13039.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13891.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18107.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18254.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6108.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13039.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18501.95 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 18254.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12705.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21039.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6230.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 12618.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 20126.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 15022 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6230.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13690.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17602.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 19558.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 13039.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16950.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16950.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 13039.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6230.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13690.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13690.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 13039.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20210.51, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6394, "minimum": 2512.9, "maximum": 9911.3355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8682.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2563.16, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6394.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5207.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8305.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6199.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2563.16, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6714.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8632.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9591.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6394.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8312.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8312.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6394.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2563.16, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6714.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6714.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6394.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9911.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5528.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2512.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6394.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5009.03 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7472.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8952.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2512.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6394.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6394.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7635.5 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8952.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5699.24 } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7925, "minimum": 866, "maximum": 18000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11530.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2287.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7925.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "per diem", "standard_charge_dollar": 866 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11030.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "per diem", "standard_charge_dollar": 1030 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2287.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8322.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10699.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11888.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7925.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10303.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10303.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7925.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2287.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8322.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8322.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7925.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12285.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6306.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2242.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7925.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3943.28 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9923.67 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11096.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2242.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7925.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7925.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10140.08 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11096.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6501.8 } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7631, "minimum": 4213.94, "maximum": 13500, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10982.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4298.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7631.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6587.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10506.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7841.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4298.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10302.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11447.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7631.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9920.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9920.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7631.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4298.22, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8012.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7631.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11828.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6457.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4213.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7631.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5443.07 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9452.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10683.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4213.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7631.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7631.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9658.35 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10683.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6657.6 } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11193, "minimum": 6765.5, "maximum": 18000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17606.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6900.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11193.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10559.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16842.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 12571.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6900.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11752.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15110.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16789.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11193.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14551.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14551.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11193.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6900.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11752.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11752.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11193.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17349.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10289.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6765.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11193.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9191.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15152.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15670.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6765.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11193.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11193.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15483.32 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 15670.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10607.32 } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5819, "minimum": 2744.86, "maximum": 9019.6205, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7612.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2799.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5819.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4565.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7282.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5435.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2799.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6110.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7855.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 8728.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5819.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7564.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7564.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5819.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2799.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6110.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6110.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5819.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9019.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4429.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2744.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5819.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3941.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6551.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8146.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2744.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5819.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5819.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6694.67 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8146.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4566.08 } ] } ] }, { "description": "Diag Laparo Separate Proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14237.5, "discounted_cash": 5695, "minimum": 580.5016, "maximum": 13155.45, "payers_information": [ { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 649.94 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 7404.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7973.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5695.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1906.56 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5980.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5980.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5695.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8828.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 8708.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1869.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5695.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5695.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7661 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7973.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1869.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5695.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5695.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7828 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7973.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8977.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 580.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5695.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9112.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 4220.85, "10th_percentile": 4220.85, "90th_percentile": 4220.85, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10536.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9112.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1906.56 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5980.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7689.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 8543.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5695.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9696, "minimum": 6804.16, "maximum": 16200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14823.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6940.24, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9696.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8890.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14180.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10584 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6940.24, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10181.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13090.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 14544.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9696.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12605.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12605.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9696.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6940.24, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10181.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10181.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9696.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15029.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8880.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6804.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9696.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9863.36 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12757.65 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13575.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6804.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9696.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9696.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13035.86 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13575.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9154.96 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15819, "minimum": 12023.26, "maximum": 26209.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26209.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 12263.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15819.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 15719.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 25071.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 18713.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 12263.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 16610.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21356.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 23729.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 15819.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 20565.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20565.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15819.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12263.73, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16610.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16610.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15819.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24519.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14694.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12023.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15819.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18674.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22556.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22147.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12023.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15819.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15819.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23048.77 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 22147.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15149.08 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7816, "minimum": 5180.44, "maximum": 12115.606, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11327.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5284.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6793.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10835.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 8087.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5284.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8207.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10552.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11724.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7816.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10161.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10161.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7816.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5284.05, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8207.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8207.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7816.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12115.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6471.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5180.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7634.73 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9748.59 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10943.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5180.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7816.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9961.18 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10943.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6671.28 } ] } ] }, { "description": "Dilation And Curettage", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7736.33, "discounted_cash": 3049, "minimum": 505.89, "maximum": 7148.3689, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 536.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5642, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4117.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4574.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 505.89 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3964.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4727.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4409.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4545.54 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8086, "minimum": 4948.48, "maximum": 14400, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11829.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5047.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8086.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7094.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11316.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 8446.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5047.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8491.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10917.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12130.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8086.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10512.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10512.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8086.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5047.45, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8491.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8491.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8086.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12534.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6973.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4948.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8086.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8015.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10181.02 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11321.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4948.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8086.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8086.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10403.04 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11321.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7189.6 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13552, "minimum": 9201.08, "maximum": 21994.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21994.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9385.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13552.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 13191.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 21039.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 15703.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9385.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18295.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 20328.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 13552.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 17618.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17618.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 13552.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9385.1, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14230.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 13552.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21006.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13968.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9201.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13552.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15543.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18928.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18973.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9201.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13552.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13552.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19341.48 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 18973.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14400.48 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6336, "minimum": 3595.38, "maximum": 10800, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8574.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3667.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6336.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5142.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8202.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6122.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3667.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6653.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8554.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9504.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6336.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8237.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8237.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6336.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3667.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6653.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6653.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6336.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9821.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4805.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3595.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6336.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5162.02 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7379.74 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8870.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3595.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6336.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6336.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.67 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8870.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4954.44 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7268, "minimum": 5257.76, "maximum": 13500, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10308.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5362.92, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6182.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9861.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7360.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5362.92, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9813, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10903.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7268.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9449.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9449.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7268.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5362.92, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7632.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7268.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11266.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6412.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5257.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6550.07 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8872.14 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10176.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5257.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7268.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9065.61 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10176.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6610.48 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12468, "minimum": 9317.06, "maximum": 21600, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19978.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9503.4, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12468.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11981.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 19110.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14264.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9503.4, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13091.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16832.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18702.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12468.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16208.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16208.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12468.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9503.4, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13091.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13091.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12468.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19325.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12218.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9317.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12468.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14031.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17193.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17455.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9317.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12468.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12468.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17568.67 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17455.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12596.24 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5820, "minimum": 4097.96, "maximum": 10350, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7615.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4179.92, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5820.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4567.29 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7284.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5437.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4179.92, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7857.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 8730.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5820.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7566.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7566.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5820.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4179.92, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6111.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5820.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9021.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4470.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4097.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5820.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4923.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6553.91 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8148.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4097.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5820.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5820.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6696.83 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8148.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4608.64 } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14683, "minimum": 866, "maximum": 26100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24097.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4771.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14683.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "per diem", "standard_charge_dollar": 866 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 23050.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "per diem", "standard_charge_dollar": 1030 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4771.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15417.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19822.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 22024.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14683.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 19088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19088.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14683.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4771.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15417.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15417.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14683.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22759.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11902.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4677.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14683.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10536.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20738.57 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20556.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4677.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14683.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14683.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21190.82 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 20556.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12270.2 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8937, "minimum": 5605.7, "maximum": 13853.0785, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13411.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5717.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8043.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12829.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 9576 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5717.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9384.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12065.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 13406.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8937.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11618.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11618.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8937.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5717.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9384.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9384.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8937.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13853.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8106.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5605.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7550.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11542.64 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12512.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5605.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8937.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11794.35 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 12512.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8356.96 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12736, "minimum": 8582.52, "maximum": 20476.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20476.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8754.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12736.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 12281.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 19587.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14620.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8754.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13373.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17194.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 19104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8754.17, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13373.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13373.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19741.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12272.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11509.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17622.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12736.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18007.29 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12651.72 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7177, "minimum": 4252.6, "maximum": 11124.7995, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10138.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4337.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7177.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6080.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9698.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7238.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4337.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7536.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9689.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10765.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7177.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9330.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9330.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7177.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4337.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7536.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7536.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7177.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11124.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5983.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4252.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7177.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5756.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8725.53 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10048.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4252.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7177.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7177.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8915.81 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10048.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6168.92 } ] } ] }, { "description": "DIVISION OF FALLOPIAN TUBE", "code_information": [ { "code": "58600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4915.5, "discounted_cash": 3049, "minimum": 580.5016, "maximum": 4915.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 580.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4915.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4117.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4574.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 706.46 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3964.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4727.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4409.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4545.54 } ] } ] }, { "description": "Drain Bl W/Cath Insertion", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7445.55, "discounted_cash": 1969, "minimum": 448.69, "maximum": 6879.6882, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 849.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3150.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3643.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3150.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 849.44 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2658.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2954.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 448.69 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2560.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 849.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3052.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 3289.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 832.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 832.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3391.36 } ] } ] }, { "description": "Drain Shoulder Lesion", "code_information": [ { "code": "23030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7850.66, "discounted_cash": 2736, "minimum": 259.224, "maximum": 7254.0098, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 259.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 882.2 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "Drain/Inj Joint/Bursa W/O Us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6556.15, "discounted_cash": 289, "minimum": 118.55, "maximum": 6057.8826, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 433.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.55 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 375.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 448.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 474.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 489.4 } ] } ] }, { "description": "Drainage Of Hip Joint", "code_information": [ { "code": "27030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8961, "discounted_cash": 6836, "minimum": 1858.82, "maximum": 8961, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8961, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8961, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8961, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8961, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 8961, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1858.82 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8887.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8961, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8961, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7661 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8961, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7828 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 8961, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Pelvis Bursa", "code_information": [ { "code": "26991", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7850.66, "discounted_cash": 1514, "minimum": 1400.5, "maximum": 7254.0098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2423.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2802.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2423.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1590.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2045.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2272.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1400.5 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2120.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1590.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1590.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2348.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2618.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2120.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2120.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2699.88 } ] } ] }, { "description": "Drainage Of Scrotum", "code_information": [ { "code": "54700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8961, "discounted_cash": 1969, "minimum": 426.63, "maximum": 8279.964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 580.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3150.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3643.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3150.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.02 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2658.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2954.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 426.63 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2560.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 673.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2067.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3052.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 3289.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 659.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 659.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2757.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3391.36 } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6678, "minimum": 2667.54, "maximum": 10351.582, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9210.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2720.89, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6678.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5524.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8811.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6576.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2720.89, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7012.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9015.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10017.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6678.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8681.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8681.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6678.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2720.89, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7012.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7012.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8550, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6678.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10351.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5565.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2667.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6678.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6600.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7927.13 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9349.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2667.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6678.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6678.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8099.99 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9349.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5738 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10104, "minimum": 4523.22, "maximum": 15750, "payers_information": [ { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13641.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 15156.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10104.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 13135.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13135.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10104.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4613.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10609.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10609.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10104.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15662.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8928.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4523.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10104.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10453.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13410.51 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14146.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4523.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10104.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10104.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13702.96 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14146.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9204.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15582.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4613.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10104.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 9345.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14905.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11125.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.68, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10609.73, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15678, "minimum": 7500.04, "maximum": 26550, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25948.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7650.04, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15679, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 15562.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 24822.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 18527.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7650.04, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 16462.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21166.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 23518.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 15678.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 20382.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20382.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 15678.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7650.04, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16462.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16462.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 15678.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24302.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 14848.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7500.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15678.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12251 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22332.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21950.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7500.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15679, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15678.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 22819.22 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 21950.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15307.92 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6978, "minimum": 2822.18, "maximum": 10816.334, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9768.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2878.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6978.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5858.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9344.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6974.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2878.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7327.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9420.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10467.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6978.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9071.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9071.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6978.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2878.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7327.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7327.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6978.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10816.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6027.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2822.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6978.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7639.03 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8407.01 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9769.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2822.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6978.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6978.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8590.35 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9769.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6213.76 } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 141598, "minimum": 64252.92, "maximum": 260114.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 260114.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 65537.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 141598, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 156005.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 248823.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 185720.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 65537.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 148677.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 191157.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 212397.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 141598.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 184077.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 184077.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 141598.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 65537.98, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 148677.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 148678.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 141598.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 219477.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 149187.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 64252.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 141598.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 222213 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 223862.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 198237.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 64252.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 141598, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 141598.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 228743.98 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 198237.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 153801.96 } ] } ] }, { "description": "Egd Place Gastrostomy Tube", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7850.66, "discounted_cash": 1807, "minimum": 300.2594, "maximum": 7254.0098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2892.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3344.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2892.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 628.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2440.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2711.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1807.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 405.26 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2350.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1807.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 628.75 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1807.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2802.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2769.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 616.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1807.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 616.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1807.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2854.78 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8480, "minimum": 5412.4, "maximum": 15300, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12561.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5520.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8480.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7533.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 12016.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 8968.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5520.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8904.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11448.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12720.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8480.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11024.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11024.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8480.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5520.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8904.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8904.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 15300, "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": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8480.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13144.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7512.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5412.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8480.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7055.45 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10810.68 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11872.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5412.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8480.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8480.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11046.43 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11872.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7745.16 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12573, "minimum": 8698.5, "maximum": 22500, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20172.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8872.47, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12573.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 12098.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 19297.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14403.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8872.47, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13201.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16973.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18859.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12573.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16345.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16345.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12573.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8872.47, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13201.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13201.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12573.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19488.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12117.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8698.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12573.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12742.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17361.42 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17602.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8698.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12573.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12573.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17740.02 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17602.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12492.12 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6788, "minimum": 4059.3, "maximum": 11700, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9415.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4140.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6788.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5647.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9006.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6722.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4140.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9164.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10182.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6788.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8825.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8825.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6788.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4140.49, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7127.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7127.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6788.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10522.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5474.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4059.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6788.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4426.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8103.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9503.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4059.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6788.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6788.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8279.97 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9503.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5643.76 } ] } ] }, { "description": "ENDOMETR ABLATE THERMAL", "code_information": [ { "code": "58353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9831.01, "discounted_cash": 4712, "minimum": 580.5016, "maximum": 9083.8532, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5151 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 580.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7540.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8718.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7540.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1643.52 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4948.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6362.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7069.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1958.08 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6126.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6598, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1643.52 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4948.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4948.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7304.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 7976.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1611.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6598, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1611.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6598, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8223.62 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42111, "minimum": 11700, "maximum": 75103.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 75103.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 27248.34, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42111.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 45043.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 71843.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 53623.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 27248.34, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 44216.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 56850.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 63166.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 42111.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 54744.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 54744.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 42111.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 27248.34, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 44216.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 44216.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 42111.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 65272.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 48660.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26714.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42111.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36102.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 64636.23 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 58955.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26714.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42111.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 42111.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 66045.77 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 58955.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 50165.32 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33098, "minimum": 3478.3, "maximum": 58343.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 58343.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 24251.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33098.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 34991.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 55810.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 41657 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 24251.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 34753.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 44683.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 49648.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 33098.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 43028.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43028.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 33098.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 24251.42, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 34753.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 34753.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 33098.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 51303.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 38043.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23775.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33098.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3478.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 50212.16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 46338.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23775.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33098.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33098.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 51307.14 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 46338.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39220.56 } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10499, "minimum": 4716.52, "maximum": 16317.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16317.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4810.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10499.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 9786.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15609.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11650.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4810.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11024.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14174.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 15749.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10499.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 13649.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13649.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10499.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4810.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11024.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11024.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10499.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16274.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10168.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4716.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10499.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13186.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14043.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14699.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4716.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10499.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10499.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14349.58 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14699.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10482.68 } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6562, "minimum": 2590.22, "maximum": 10171.7975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8995.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 2642.02, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5394.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 8604.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 2642.02, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6890.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8859.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 9843.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8531.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8531.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 2642.02, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6890.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6890.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10171.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5683.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2590.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4280.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7741.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9187.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2590.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6562.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7910.32 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9187.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5859.6 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10083, "minimum": 8466.54, "maximum": 17100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15543.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8635.87, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10083.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 9322.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 14868.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11097.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8635.87, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10587.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13612.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 15125.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10083.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 13108.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13108.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10083.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8635.87, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10587.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10587.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 17100, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10083.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15629.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 9465.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8466.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10083.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8901.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13376.76 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14116.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8466.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10083.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10083.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13668.47 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14116.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9758.4 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6862, "minimum": 4252.6, "maximum": 11250, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9554 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4337.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5730.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9139.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6821.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4337.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9264.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10294.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6862.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 8921.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8921.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6862.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4337.65, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7206.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6862.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10637.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5806.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4252.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5542.77 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8222.44 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9608.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4252.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6862.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8401.75 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9608.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5985.76 } ] } ] }, { "description": "Ex Arm/Elbow Tum Deep < 5 Cm", "code_information": [ { "code": "24076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 2736, "minimum": 467.0702, "maximum": 5234.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 467.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1080.01 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "EXC ABD LES SC < 3 CM", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5304.5, "discounted_cash": 1555, "minimum": 633.79, "maximum": 4901.358, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 813.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 646.47 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 866.35 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 646.47 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 633.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 633.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Arm/Elbow Les Sc 3 Cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 2736, "minimum": 807.77, "maximum": 5234.46, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 3999.25, "10th_percentile": 3999.25, "90th_percentile": 3999.25, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 807.77 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "EXC ARMELBOW LES SC < 3 CM", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2652.25, "discounted_cash": 1555, "minimum": 400.3459, "maximum": 2652.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2652.25, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 970.43 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2652.25 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2652.25 } ] } ] }, { "description": "Exc Back Les Sc 3 Cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6531.54, "discounted_cash": 1555, "minimum": 847.14, "maximum": 7785.9104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 934.58 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7253.85, "discounted_cash": 2736, "minimum": 847.14, "maximum": 13443.6456, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1466.66 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "EXC FACE LES SBQ 2 CM<", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7426.3, "discounted_cash": 1555, "minimum": 297.12, "maximum": 6861.9012, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 381.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.06 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 672.68 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 303.06 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 297.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 297.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Foot/Toe Tum Deep <1.5Cm", "code_information": [ { "code": "28045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 2736, "minimum": 467.0702, "maximum": 5234.46, "payers_information": [ { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 467.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 989.72 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Foot/Toe Tum Sc < 1.5 Cm", "code_information": [ { "code": "28043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6090.39, "discounted_cash": 1555, "minimum": 400.3459, "maximum": 5627.5204, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 798.8 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Foot/Toe Tum Sc 1.5 Cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7850.66, "discounted_cash": 2736, "minimum": 847.14, "maximum": 7254.0098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1005.57 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc Forearm Les Sc 3 Cm/>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6757.83, "discounted_cash": 1555, "minimum": 844.3, "maximum": 7913.7458, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 844.3 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg >4 Cm", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5834.95, "discounted_cash": 2736, "minimum": 333.6216, "maximum": 13443.6456, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 333.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.89 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 1555, "minimum": 300.2594, "maximum": 8271.4632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.36 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6895.85, "discounted_cash": 1555, "minimum": 333.6216, "maximum": 8271.4632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 333.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.61 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 1555, "minimum": 333.6216, "maximum": 8271.4632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 333.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 459.71 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Hand Les Sc < 1.5 Cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6556.15, "discounted_cash": 1555, "minimum": 467.0702, "maximum": 6057.8826, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 467.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 994.55 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Hand Les Sc 1.5 Cm/>", "code_information": [ { "code": "26111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5749.98, "discounted_cash": 1555, "minimum": 829.13, "maximum": 5312.9815, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 829.13 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Hip Pelvis Les Sc 3 Cm/>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8221.5, "discounted_cash": 2736, "minimum": 847.14, "maximum": 14300.1012, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 4220.85, "10th_percentile": 4220.85, "90th_percentile": 4220.85, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 933.2 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc Leg/Ankle Les Sc 3 Cm/>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10609, "discounted_cash": 2736, "minimum": 822.93, "maximum": 9802.716, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 822.93 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc legankle tum < 3 cm", "code_information": [ { "code": "27618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2940.33, "discounted_cash": 1555, "minimum": 300.2594, "maximum": 2878.5815, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 891.16 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Neck Les Sc < 3 Cm", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 1555, "minimum": 300.2594, "maximum": 5234.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 818.79 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Neck Les Sc 3 Cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6015.2, "discounted_cash": 2736, "minimum": 847.14, "maximum": 13443.6456, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 2668.35, "10th_percentile": 2668.35, "90th_percentile": 2668.35, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 887.02 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc Neck Tum Deep 5 Cm/>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6895.85, "discounted_cash": 2736, "minimum": 847.56, "maximum": 6371.7654, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.51 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1450.81 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.51 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7081.25, "discounted_cash": 1555, "minimum": 834.64, "maximum": 8018.8508, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 2668.35, "10th_percentile": 2668.35, "90th_percentile": 2668.35, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 834.64 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc Shoulder Tum Deep < 5 Cm", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7982.5, "discounted_cash": 2736, "minimum": 467.0702, "maximum": 7375.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 467.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1071.74 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 } ] } ] }, { "description": "Exc Shoulder Tum Deep 5 Cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7291.63, "discounted_cash": 2736, "minimum": 847.14, "maximum": 6737.4661, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS 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"standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc skin abd", "code_information": [ { "code": "15830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13469.91, "discounted_cash": 6255, "minimum": 2328.88, "maximum": 12446.1968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10009.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11573.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10009.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6568.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8445.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9383.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2328.88 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8132.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8758.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6568.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6568.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9696.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 9335.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7661 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8758.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6255.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7828 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 8758.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9623.76 } ] } ] }, { "description": "Exc Skn H/P/P/U Smpl/Ntrm", "code_information": [ { "code": "11470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 2736, "minimum": 400.3459, "maximum": 5234.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 814.66 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc Skn Hdrdnt Ax Smpl/Ntrm", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6264.98, "discounted_cash": 2736, "minimum": 400.3459, "maximum": 5788.8415, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 756.77 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 938.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 920.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc Thigh/Knee Les Sc 3 Cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7956.75, "discounted_cash": 2736, "minimum": 831.89, "maximum": 13443.6456, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 831.89 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 } ] } ] }, { "description": "Exc Thigh/Knee Tum Dep 5Cm/>", "code_information": [ { "code": "27339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7850.66, "discounted_cash": 2736, "minimum": 847.14, "maximum": 7254.0098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1087.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5062.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4378.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3694.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4104.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1496.3 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3557.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 864.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2873.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4241.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4510.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 847.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2736.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3831.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4649.74 } ] } ] }, { "description": "Exc Tr-Ext B9+Marg >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7384.48, "discounted_cash": 1555, "minimum": 333.6216, "maximum": 6910.097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 333.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 619.61 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Exc tr-ext b9+marg 0.6-1 cm", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4597.24, "discounted_cash": 382, "minimum": 252.25, "maximum": 4247.8498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 294.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 612.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 708.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 612.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.3 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 517.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 574.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 294.3 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 497.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 257.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 593.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 602.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 536.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 382.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 536.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 621.6 } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 1.1-2 Cm", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5834.95, "discounted_cash": 667, "minimum": 257.4, "maximum": 5391.4938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1067.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1234.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1067.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 900.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1000.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 328.07 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 867.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 933.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 700.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1034.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1111.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 933.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 933.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1145.7 } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 2.1-3Cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7327.98, "discounted_cash": 667, "minimum": 257.4, "maximum": 6771.0535, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1067.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1234.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1067.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 900.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1000.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 379.07 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 867.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 933.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 700.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1034.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1111.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 933.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 933.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1145.7 } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 3.1-4 Cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6180, "discounted_cash": 1555, "minimum": 333.6216, "maximum": 5710.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 333.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2878.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2489.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2333.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 429.38 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2022.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 535.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1633.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2411.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2615.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1555.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2178.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2696.06 } ] } ] }, { "description": "Excise Intrspinl Lesion Lmbr", "code_information": [ { "code": "63267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18884, "discounted_cash": 6836, "minimum": 341.4104, "maximum": 17448.816, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 341.41 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12646.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9228.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10254.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2743.09 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8887.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10596.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "EXCISE WRIST TENDON SHEATH", "code_information": [ { "code": "25118", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.02, "discounted_cash": 1514, "minimum": 357.606, "maximum": 1192.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1192.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 533.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 531.06 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 754.7 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.06 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1192.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 520.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1192.02 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 520.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1192.02 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1192.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1192.02 } ] } ] }, { "description": "Exciserepair mouth lesion", "code_information": [ { "code": "40814", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4370.77, "discounted_cash": 3123, "minimum": 467.0702, "maximum": 4370.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 467.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4370.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4370.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4370.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1063.85 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3279.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4216.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4370.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 765.72 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4060.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4370.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1063.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3279.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3279.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4370.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4266.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1042.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4370.77 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4370.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1042.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4370.77 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4370.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4370.77 } ] } ] }, { "description": "Excision Breast Lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10048.7, "discounted_cash": 3688, "minimum": 547.22, "maximum": 16932.0228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5902.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6824.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5902.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1259.51 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3873.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4979.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 5533.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1080.69 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4795.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Early Detection Works", "plan_name": "Early Detection Works Program", "methodology": "fee schedule", "standard_charge_dollar": 547.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5164.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1259.51 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3873.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3873.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5717.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5292.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1234.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5164.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1234.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3688.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 5164.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5455.68 } ] } ] }, { "description": "Excision lesion mouth roof", "code_information": [ { "code": "42106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2185.38, "discounted_cash": 3123, "minimum": 217.1877, "maximum": 2185.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2185.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 217.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1063.85 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 543.11 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1063.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2185.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1042.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2185.38 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1042.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2185.38 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2185.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2185.38 } ] } ] }, { "description": "Excision Of Tongue Lesion", "code_information": [ { "code": "41110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 3123, "minimum": 300.2594, "maximum": 5665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4997.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5665, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4997.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1063.85 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3279.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4216.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4685.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.05 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4060.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4372.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1063.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3279.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3279.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4841.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4266.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1042.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4372.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1042.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3123.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4372.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4398.12 } ] } ] }, { "description": "Excision Of Umbilicus", "code_information": [ { "code": "49250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10609, "discounted_cash": 3373, "minimum": 580.5016, "maximum": 9802.716, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 580.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3373.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5397.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6240.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5397.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1143.18 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4553.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 5059.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3373.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1170.3 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4385.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4722.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3373.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1143.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3541.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3373.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5228.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5647.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1120.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3373.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3373.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4722.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1120.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3373.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3373.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4722.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5822.32 } ] } ] }, { "description": "Excision Olecranon Bursa", "code_information": [ { "code": "24105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7389.01, "discounted_cash": 3082, "minimum": 400.3459, "maximum": 6827.4452, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 694.04 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 } ] } ] }, { "description": "Excision Vaginal Cyst/Tumor", "code_information": [ { "code": "57135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 3049, "minimum": 376.32, "maximum": 5642.0005, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 580.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5642, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4879.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4117.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4574.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 376.32 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3964.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1033.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3202.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4727.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4409.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1012.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3049.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4269.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4545.54 } ] } ] }, { "description": "Exploration of knee joint", "code_information": [ { "code": "27310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10072.62, "discounted_cash": 3082, "minimum": 600.5189, "maximum": 9307.1009, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1449.43 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 } ] } ] }, { "description": "Explore Limb Vessels", "code_information": [ { "code": "35860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6695, "discounted_cash": 2974, "minimum": 667.2432, "maximum": 6375, "payers_information": [ { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1682.39 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1053.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 4835.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1032.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1032.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4985.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 667.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1053.23 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "Explore Parathyroid Glands", "code_information": [ { "code": "60500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17504.8, "discounted_cash": 5577, "minimum": 934.1405, "maximum": 16174.4352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5151 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 934.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5577.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8923.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10317.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8923.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1935.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5856, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7529.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 8365.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5577.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1911.2 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 7250.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7808, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5577.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1935.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5856, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5856, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5577.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8644.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 8417.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1897.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5577.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5577.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7661 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7808, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1897.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5577.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5577.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 7828 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7808, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8677.58 } ] } ] }, { "description": "Exploretreat ankle joint - 27610 - ", "code_information": [ { "code": "27610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10211.17, "discounted_cash": 3082, "minimum": 600.5189, "maximum": 9435.1211, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1288.15 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 } ] } ] }, { "description": "Exploretreat ankle joint - 27620 - ", "code_information": [ { "code": "27620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7072.67, "discounted_cash": 3082, "minimum": 400.3459, "maximum": 6535.1471, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5702.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4932.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4161.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4623.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 888.41 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 4007.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1069.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3236.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4778.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5131.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3082.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4315.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5290.46 } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 142423, "minimum": 91082.96, "maximum": 280225.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 261650.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 92904.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 142424, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 235389.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 250291.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 280225.31 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 92904.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 149545.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 192272.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 213635.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 142423.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 185151.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 185151.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 142423.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 92904.62, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 149545.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 149545.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 142423.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 220756.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 139936.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 91082.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 142423.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 226320 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 225183.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 199393.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 91082.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 142424, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 142423.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 230094.34 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 199393.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 144264.72 } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27387, "minimum": 11700, "maximum": 51111.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 47723.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 15457.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27388, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 42933.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 45651.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 51111.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 15457.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 28757.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 36973.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 41081.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 27387.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 35604.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35604.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 27387.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15457.81, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 28757.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 28757.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 27387.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 42451.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 22359.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15154.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27387.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41279.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 41072.13 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 38343.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15154.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27388, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 27387.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 41967.79 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 38343.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23050.8 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17926, "minimum": 12989.76, "maximum": 30128.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30128.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 13249.56, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 18069.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 28821 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 21511.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 13249.56, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 18823.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24201.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 26890.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 17926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 23304.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23304.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 17926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13249.56, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18823.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18823.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 17926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27786.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 18490.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12989.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20429.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 25929.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 25097.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12989.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 26495.25 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 25097.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19062.32 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32644, "minimum": 20683.1, "maximum": 57498.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 57498.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 21096.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 34484.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 55001.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 41053.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 21096.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 34276.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 44069.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 48966.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 32644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 42437.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 42437.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 32644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21096.76, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 34276.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 34276.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 32644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 50598.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 33766.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20683.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48111.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 49484.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 45701.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20683.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 32644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 50563.53 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 45701.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34811.04 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13020, "minimum": 7809.32, "maximum": 21005.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21005.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7965.51, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13020.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 12597.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 20093.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14997.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7965.51, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13671.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17577.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 19530.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 13020.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16926.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16926.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 13020.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7965.51, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13671.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13671.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 13020.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20181.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12312.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7809.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13020.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10915.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18077.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18228.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7809.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13020.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13020.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18471.78 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 18228.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12693.52 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12418, "minimum": 7190.76, "maximum": 19884.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19884.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7334.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12418.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11926.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 19021.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 14197.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7334.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 13039.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16764.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18627.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12418.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 16143.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16143.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12418.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7334.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13039.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13039.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12418.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19248.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 12056.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7190.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12418.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17221.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17113.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17385.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7190.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12418.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12418.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 17486.76 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 17385.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12429.8 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23420, "minimum": 14574.82, "maximum": 40344.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 40344.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 14866.32, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23420.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 24196.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 38593.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 28805.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 14866.32, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 24591.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31617.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 35130.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 23420.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 30446.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30446.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 23420.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14866.32, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 24591.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 24591.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 23420.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 36301.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 24865.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14574.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23420.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39167.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 34721.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 32788.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14574.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23420.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23420.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 35478.96 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 32788.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25634.8 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9471, "minimum": 5219.1, "maximum": 14681.4605, "payers_information": [ { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 9471.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14681.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 8497.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5219.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9471.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14071.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12398 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13260.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5219.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9471.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9471.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 12668.36 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 13260.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8760.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14405.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5323.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9471.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 8639.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 13780.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 10285.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5323.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 9945.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12787.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 14207.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 9471.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 12313.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12313.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 9471.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5323.48, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9945.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9945.51, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Extraction Of Lens", "code_information": [ { "code": "66920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5665, "discounted_cash": 2174, "minimum": 600.5189, "maximum": 5234.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2174.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3478.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4022.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3478.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 770.02 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2282.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2935.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 3261.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2174.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1481.13 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2826.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3043.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2174.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 770.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2282.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2282.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2174.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3370.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 3726.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 754.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2174.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2174.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4510 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3043.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 754.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2174.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2174.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 4608 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 3043.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3842.18 } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11840, "minimum": 6533.54, "maximum": 20012.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18810.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6664.21, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11840.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11281.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 17993.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 13430.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6664.21, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12432.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15984.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 17760.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11840.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15392.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15392.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11840.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6664.21, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12432.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12432.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11840.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18352.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11198.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6533.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11840.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20012.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16188.59 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16576.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6533.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11840.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11840.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16541.62 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 16576.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11545.16 } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40892, "minimum": 3887, "maximum": 80550, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 72837.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40892.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 65527.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 69675.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 78008.44 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 42937.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 55205.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 61339.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 40892.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 53160.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53160.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 40892.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 42937.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 42937.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 40892.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 63383.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 44387.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40892.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6312.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "per diem", "standard_charge_dollar": 3887 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 57249.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40892.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 40892.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 64053.1 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 57249.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 45760.36 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10867, "minimum": 5644.36, "maximum": 17001.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17001.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5757.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10196.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16263.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 12138.88 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5757.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11411.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14671.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16301.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10867.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14127.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14127.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10867.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5757.25, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11411.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11411.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10867.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16844.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10447.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5644.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16573.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14631.85 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15214.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5644.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10867.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 14950.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 15214.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10770.72 } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7575, "minimum": 4291.26, "maximum": 12150, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10878.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4377.09, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7575.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6524.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10406.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7767.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4377.09, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7954.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10226.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11363, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7575.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9847.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9847.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7575.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4377.09, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7954.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7954.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 12150, "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": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7575.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11741.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6252.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4291.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7575.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5428.45 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9362.57 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10605.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4291.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7575.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7575.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9566.74 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10605.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6446.32 } ] } ] }, { "description": "Fixation Of Knee Joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3090, "discounted_cash": 1514, "minimum": 298.43, "maximum": 5453.4203, "payers_information": [ { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 298.43 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1969.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2120.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.06 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1590.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1590.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2348.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 2618.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 520.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2120.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 520.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2120.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2699.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2423.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 1455.46, "10th_percentile": 1455.46, "90th_percentile": 1455.46, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2802.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2423.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 531.06 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1590.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2045.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2272.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1514.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14043, "minimum": 8969.12, "maximum": 22907.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22907.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14043.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 13738.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 21912.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 16355.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 14745.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18958.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 21065.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14043.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 18256.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18256.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14043.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9148.5, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14745.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14745.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14043.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21767.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13083.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8969.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14043.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16359.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19714.45 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19660.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8969.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14043.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14043.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20144.37 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 19660.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13488.48 } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20118, "minimum": 9433.04, "maximum": 34204.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34204.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9621.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20118.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 20514.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 32720.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 24422.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9621.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27160.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 30177.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 20118.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 26154.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26154.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 20118.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9621.7, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 21124.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 21124.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 32850, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 36000, "10th_percentile": 36000, "90th_percentile": 36000, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 20118.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 31183.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 18675.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9433.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20118.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25248.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 29437.73 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 28166.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9433.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20118.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20118.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 30079.68 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 28166.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19253.08 } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13539, "minimum": 8543.86, "maximum": 21970.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21970.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8714.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13539.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 13177.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 21016.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 15687 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8714.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 14216.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18278.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 20309.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 13539.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 17601.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17601.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 13539.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8714.74, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14216.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14216.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 13539.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20986.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13024.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13539.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12323.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 18908.66 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18955.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13539.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13539.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19321.01 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 18955.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13427.68 } ] } ] }, { "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": 11114, "minimum": 10472.28, "maximum": 18450, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17460.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 10844.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10472.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 16702.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 12467 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 10844.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 11670.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15004.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 16672.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11114.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14449.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14449.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11114.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10844.13, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11670.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11670.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11114.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17227.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10783.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10631.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11114.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11184.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15027.37 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15560.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10631.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11114.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15355.07 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 15560.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11117.28 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7626, "minimum": 6321.45, "maximum": 12600, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10974.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6821.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7626.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 6581.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 10497.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7835.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6821.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8008.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10296.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 11440.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7626.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9914.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9914.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7626.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6821.94, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8008.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8008.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7626.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11821.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 6348.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6688.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7626.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6321.45 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9444.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10677.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6688.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7626.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7626.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9650.8 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 10677.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6545.12 } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12056, "minimum": 10514.68, "maximum": 19212.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19212.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 11908.83, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12056.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11522.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 18378.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 13717.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 11908.83, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12659.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16276.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18084.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15673.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15673.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11908.83, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12659.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12659.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18687.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10514.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11675.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14547.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16534.53 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11675.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12056.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16895.1 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 16879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10839.88 } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7037, "minimum": 4462.4, "maximum": 13050, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9878.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7037.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5924.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9449.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7053.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7389.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9500.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10556.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7037.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9148.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9148.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7037.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7389.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7389.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7037.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10908.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5867.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7037.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4462.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8501.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9852.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7037.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7037.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8687.34 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9852.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6048.84 } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10173, "minimum": 9422.7, "maximum": 17550, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15710.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 9740, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 9422.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 15028.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 11217.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 9740, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 10682.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13734.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 15260.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 10173.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 13225.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13225.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 10173.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9740, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10682.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10682.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 10173.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15769.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 9506.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9549.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10173.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12687.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13521.25 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14243.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9549.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10173.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 13816.11 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 14243.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9800.2 } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7047, "minimum": 5477.44, "maximum": 12600, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9897.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5935.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9467.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 7066.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7399.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9514.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10571.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 7047.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9161.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9161.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 7047.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6151.58, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7399.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7399.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 7047.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10923.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5728.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5477.44 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8517.76 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9866.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6030.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7047.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8703.51 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9866.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5905.96 } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29202, "minimum": 2942, "maximum": 54726, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 51098.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3982.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29202.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 45969.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 48880.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 54726 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3982.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 30662.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 39423.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 43804.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 29202.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 37963.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 37963.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 29202.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3982.75, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 30662.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 30662.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 29202.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 45264.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 31139.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3904.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29202.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39787.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "per diem", "standard_charge_dollar": 2942 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 40883.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3904.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29202.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29202.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 44935.78 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 40883.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32102.4 } ] } ] }, { "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": 48993, "minimum": 29569.4, "maximum": 94141.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 87901.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 31191.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48993.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 79079.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 84085.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 94141.69 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 31191.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 51442.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 66140.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 73489.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 48993.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 63690.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 63690.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 48993.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 31191.66, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 51442.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 51442.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 48993.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 75939.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 45642.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30580.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48993.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29569.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 75650.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 68590.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30580.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48993.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 48993.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 77300.19 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 68590.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47053.88 } ] } ] }, { "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": 22950, "minimum": 13724.3, "maximum": 42273, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39470.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 13998.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 35509.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 37757.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 42273 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 13998.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 24097.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30982.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 34425.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 22950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 29835.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29835.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 22950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13998.79, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 24097.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 24097.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 22950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 35572.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 21664.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13724.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14974.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 33969.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 32130.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13724.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 34710.56 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 32130.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22334.88 } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16293, "minimum": 3128.5, "maximum": 29014.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27090.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8793.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16293.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 24371.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 25914.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 29014.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8793.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 17107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21995.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 24439.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 16293.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 21181.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21181.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 16293.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8793.6, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17107.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 16293.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25254.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13829.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8621.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16293.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3128.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23315.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22810.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8621.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16293.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16293.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 23823.64 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 22810.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14257.6 } ] } ] }, { "description": "Fusion Of Ankle Joint Open", "code_information": [ { "code": "27870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25779.9, "discounted_cash": 12095, "minimum": 400.3459, "maximum": 23820.6276, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 400.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19352.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 22376.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19352.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12700.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16328.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18143.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2042.85 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15724.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16933.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12700.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12700.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18747.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 19638.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16933.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16933.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20245.84 } ] } ] }, { "description": "Fusion Of Big Toe Joint", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12012.2, "discounted_cash": 6836, "minimum": 533.7946, "maximum": 12012.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 533.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 2021.48, "10th_percentile": 2021.48, "90th_percentile": 7634.92, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12012.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9228.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10254.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1608.64 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8887.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10596.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10876.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11212.84 } ] } ] }, { "description": "Fusion of foot bones - 28715 - ", "code_information": [ { "code": "28715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11115.65, "discounted_cash": 12095, "minimum": 533.7946, "maximum": 11115.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 533.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1864.34 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 11115.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 11115.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11115.65 } ] } ] }, { "description": "Fusion of foot bones - 28725 - ", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9105.87, "discounted_cash": 12095, "minimum": 514.1494, "maximum": 9105.87, "payers_information": [ { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1545.92 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 9105.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9105.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9105.87 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9105.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 514.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 2175.11, "10th_percentile": 2175.11, "90th_percentile": 2175.11, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9105.87, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of foot bones - 28730 - ", "code_information": [ { "code": "28730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6373.26, "discounted_cash": 12095, "minimum": 533.7946, "maximum": 6373.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 533.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 5259.62, "10th_percentile": 5259.62, "90th_percentile": 5259.62, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1460.46 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 6373.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6373.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6373.26 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6373.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6373.26 } ] } ] }, { "description": "Fusion Of Foot Bones - 28740 - OR36028740", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16125.7, "discounted_cash": 6836, "minimum": 533.7946, "maximum": 14900.1468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 533.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 1237.14, "10th_percentile": 1237.14, "90th_percentile": 3750.95, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 2175.11, "10th_percentile": 2175.11, "90th_percentile": 2175.11, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12646.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9228.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10254.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1685.14 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8887.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2363.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10596.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10876.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2317.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11212.84 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8188, "minimum": 5837.66, "maximum": 13050, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12018.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5954.41, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8188.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 7208.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11496.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 8581.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5954.41, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8597.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11054.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12282.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8188.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 10644.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10644.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8188.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5954.41, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8597.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8597.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8188.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12691.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7261.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5837.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8188.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7516.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10343.44 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11463.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5837.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8188.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8188.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10569 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11463.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7486 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13771, "minimum": 10283.56, "maximum": 22402.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22402.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 10489.23, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 13435.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 21429.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 15995 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 10489.23, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 14460.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18591.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 20657.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 13771.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 17903.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17903.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 13771.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10489.23, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14460.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14460.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 20250, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 9000, "90th_percentile": 22500, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 13771.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21346.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13107.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10283.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14560.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19279.92 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19280.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10283.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13771.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 19700.36 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 19280.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13512.8 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5879, "minimum": 3556.72, "maximum": 9113.597, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5864.21 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6648.83 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8231.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3556.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5879.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5879.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6793.82 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 8231.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4816.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7725.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3627.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5879.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 4633.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7390.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 5516 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3627.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 6173.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7937.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 8819.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5879.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 7643.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7643.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5879.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3627.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6173.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6173.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5879.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9113.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4672.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3556.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5879.74, "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": 6930, "minimum": 4963.48, "maximum": 13500, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9679 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5402.35, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 5805.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 9258.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 6910.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5402.35, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 7276.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9355.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 10395.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 6930.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 9009.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9009.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 6930.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5402.35, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7276.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7276.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 6930.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10741.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 5949.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5296.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4963.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8330.02 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9702.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5296.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6930.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8511.67 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 9702.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6133.96 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11457, "minimum": 5335.08, "maximum": 20250, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18098.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 5441.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 10854.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 17312.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 12922 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 5441.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12030.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15467.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 17186.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 11457.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 14894.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14894.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 11457.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 5441.78, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12030.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12030.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 20250, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 11457.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17759.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 10817.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5335.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11457.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10754.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15575.81 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16040.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5335.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11457.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11457.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 15915.47 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 16040.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11152.24 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5310, "minimum": 3595.38, "maximum": 10350, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6666.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 3667.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5310.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 3998.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6377.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 4760 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 3667.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 5575.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7169, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 7965.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 5310.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 6903.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 6903.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 5310.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 3667.29, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5575.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5575.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 5310.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 8231.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 4168.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3595.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5310.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3678.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 5737.57 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7434.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3595.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5310.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5310.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 5862.69 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 7434.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4297.8 } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12099, "minimum": 7268.08, "maximum": 20662.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19293.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 7413.44, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 17356.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 18455.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 20662.69 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 7413.44, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 12705, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16334.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 18149.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 12099.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 15729.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15729.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 12099.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7413.44, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12705, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12704.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 12099.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18754.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 11750.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12099.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13356.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16604.14 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16939.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12099.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 16966.23 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 16939.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12114.4 } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8462, "minimum": 4716.52, "maximum": 13417.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12528.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 4810.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8462.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 11270.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 11984.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 13417.69 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 4810.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11424.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 12693.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 8462.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 11001.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11001.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 8462.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 4810.85, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8885.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8885.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 8462.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13116.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 7613.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4716.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8462.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8370.44 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10782.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11847.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4716.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8462.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8462.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 11017.33 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 11847.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7848.52 } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14670, "minimum": 8389.22, "maximum": 24072.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24072.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "case rate", "standard_charge_dollar": 8557, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14670, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "case rate", "standard_charge_dollar": 14437.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "case rate", "standard_charge_dollar": 23027.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "case rate", "standard_charge_dollar": 17187.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "case rate", "standard_charge_dollar": 8557, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "case rate", "standard_charge_dollar": 15403.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19804.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "case rate", "standard_charge_dollar": 22005.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "case rate", "standard_charge_dollar": 14670.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "case rate", "standard_charge_dollar": 19071.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19071.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "case rate", "standard_charge_dollar": 14670.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8557, "additional_payer_notes": "102% of State Medicaid Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15403.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15403.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "case rate", "standard_charge_dollar": 14670.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22738.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "case rate", "standard_charge_dollar": 13179.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8389.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14670.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16001.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 20717.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20538.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8389.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14670, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14670.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 21169.26 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "case rate", "standard_charge_dollar": 20538.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13587.28 } ] } ] }, { "description": "Hc Bladder Instillation Anticarcinogenic Agent", "code_information": [ { "code": "51720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 903.64, "discounted_cash": 656, "minimum": 166.1, "maximum": 903.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 903.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 333.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 903.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 903.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 903.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.72 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 689.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 886.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 903.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 166.1 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 854.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 903.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.72 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 689.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 689.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 903.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 445.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 903.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 656.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 903.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 459.06 } ] } ] }, { "description": "Hc Breath Hydrogen/Methane Test", "code_information": [ { "code": "91065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 805.43, "discounted_cash": 203, "minimum": 40.0346, "maximum": 744.2173, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 40.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 376.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.61 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 274.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 305.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 264.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 284.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.61 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 213.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 315.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 121.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 284.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 284.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.26 } ] } ] }, { "description": "Hc Dup-Scan Artl Infl&Ven O/F Pen Vsl Compl", "code_information": [ { "code": "93980", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1948.5, "discounted_cash": 98, "minimum": 46.9, "maximum": 1800.414, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 126.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 182.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.84 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 147.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 98.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 128.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 98.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 47.84 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 103.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 98.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 152.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 212.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 472 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "140.00% 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": 98.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 98.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 482 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 219.35 } ] } ] }, { "description": "Hc Education&Training Self-Mgmt Nonphys 1 Pt", "code_information": [ { "code": "98960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.54, "minimum": 50.562, "maximum": 155.731, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137 } ] } ] }, { "description": "Hc Iaad Ia Hepatitis B Surface Ag Neutralization", "code_information": [ { "code": "87341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.16, "discounted_cash": 10, "minimum": 10.33, "maximum": 145.2158, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 16.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.44 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 22.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.04 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.71 } ] } ] }, { "description": "Hc Intrapulmonary Surfactant Administj Phys/Qhp", "code_information": [ { "code": "94610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.05, "discounted_cash": 206, "minimum": 22.55, "maximum": 356.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 356.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 278.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 309.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 268.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 288.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 319.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 94.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 288.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 288.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 97.15 } ] } ] }, { "description": "Hc Irrigation Vagina&/Appl Medicament Tx Disease", "code_information": [ { "code": "57156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1507.72, "discounted_cash": 287, "minimum": 133.99, "maximum": 1507.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1507.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 171.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 459.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 531.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 459.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.67 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 387.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 430.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 393.54 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 373.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 136.67 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 301.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 444.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 520.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 401.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 401.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 536.7 } ] } ] }, { "description": "Hc Penile Plethysmography", "code_information": [ { "code": "54240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 526.72, "discounted_cash": 203, "minimum": 158.016, "maximum": 526.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 526.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 376.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 274.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 305.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 209.52 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 264.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 284.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 213.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 315.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 264.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 526.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 284.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 203.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 526.72 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 284.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 272.64 } ] } ] }, { "description": "Hc Placement Needle Pelvic Organ Radioelement Appl", "code_information": [ { "code": "55920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9118.78, "discounted_cash": 4712, "minimum": 893.92, "maximum": 8718.791, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1128.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7540.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8718.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7540.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1128.47 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4948.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6362.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7069.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 893.92 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6126.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6598, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1128.47 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4948.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4948.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7304.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 7976.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1106.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6598, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1106.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6598, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8223.62 } ] } ] }, { "description": "Hc Plmt Expandable Cath Brst Following Prtl Mast", "code_information": [ { "code": "19296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23595.6, "discounted_cash": 7700, "minimum": 5302, "maximum": 21802.3344, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5302 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7700.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12320.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14245.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12320.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8085.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10395.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 11550.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 7700.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7799.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 10010.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10780.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7700.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8085.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8085.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 7700.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11935.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 14332.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7700.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7700.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10780.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7700.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7700.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 10780.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14775.46 } ] } ] }, { "description": "Hc Prgrmg Dev Eval Scrms Phys/Qhp In Person", "code_information": [ { "code": "93285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.45, "discounted_cash": 35, "minimum": 15.66, "maximum": 223.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 65.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.97 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 52.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 45.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 82.84 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.97 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 54.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 71.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.45 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.45 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 49.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.93 } ] } ] }, { "description": "Hc Vnpnxr 3 Years/> Phys/Qhp Skill", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.65, "minimum": 13.52, "maximum": 43.1046, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 17.35 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 } ] } ] }, { "description": "Hc (Sup Shell A4213) 20+ Cc Syringe Only", "code_information": [ { "code": "A4213", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 3.05, "10th_percentile": 2.14, "90th_percentile": 6.41, "count": "16" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 2.14, "10th_percentile": 2.14, "90th_percentile": 4.27, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4215) Sterile Needle", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 11.44, "10th_percentile": 2.14, "90th_percentile": 109.75, "count": "63" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 4.27, "10th_percentile": 2.14, "90th_percentile": 76.83, "count": "24" } ] } ] }, { "description": "Hc (Sup Shell A4223) Infusion Supplies W/O Pump", "code_information": [ { "code": "A4223", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 4.8, "10th_percentile": 4.8, "90th_percentile": 31.7, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 4.8, "10th_percentile": 4.8, "90th_percentile": 8.9, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4556) Electrodes, Pair", "code_information": [ { "code": "A4556", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 566.28, "10th_percentile": 566.28, "90th_percentile": 566.28, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4559) Coupling Gel Or Paste", "code_information": [ { "code": "A4559", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 2.14, "10th_percentile": 2.14, "90th_percentile": 2.14, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4565) Slings - A4565 - 27400063", "code_information": [ { "code": "A4565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 19.07, "10th_percentile": 18.94, "90th_percentile": 216.43, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 216.43, "10th_percentile": 216.43, "90th_percentile": 216.43, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4648) Implantable Tissue Marker - A4648 - 27800001", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 35, "median_amount": 393.65, "10th_percentile": 393.65, "90th_percentile": 393.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 478.97, "10th_percentile": 478.97, "90th_percentile": 478.97, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 448.35, "10th_percentile": 416.21, "90th_percentile": 928.6, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4648) Implantable Tissue Marker - A4648 - 27800080", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 478.97, "10th_percentile": 478.97, "90th_percentile": 478.97, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 448.35, "10th_percentile": 416.21, "90th_percentile": 928.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 35, "median_amount": 393.65, "10th_percentile": 393.65, "90th_percentile": 393.65, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4657) Syringe W/Wo Needle", "code_information": [ { 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"percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 521.79, "10th_percentile": 50.28, "90th_percentile": 745.42, "count": "16" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 521.79, "10th_percentile": 25.62, "90th_percentile": 572.07, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1897) Lead, Neurostim Test Kit", "code_information": [ { "code": "C1897", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 7930, "10th_percentile": 7930, "90th_percentile": 7930, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 5551, "10th_percentile": 5551, "90th_percentile": 5551, "count": "1 through 10" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 21429.49, "10th_percentile": 21429.49, "90th_percentile": 21429.49, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C2617) Stent Non-Cor Temp W/O Deliv System", "code_information": [ { "code": "C2617", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 654.96, "10th_percentile": 654.96, "90th_percentile": 654.96, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 668.34, "10th_percentile": 668.34, "90th_percentile": 668.34, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C9359) Implnt,Bon Void Filler-Putty", "code_information": [ { "code": "C9359", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 887.6, "10th_percentile": 887.6, "90th_percentile": 887.6, "count": "1 through 10" } ] } ] }, { "description": "Hc 2D Tee W Or W/O Fol W/Con,In", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3448.86, "discounted_cash": 738, "minimum": 738.53, "maximum": 3186.7466, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1181.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 2103.8, "10th_percentile": 2103.8, "90th_percentile": 2103.8, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1366.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1181.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 775.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 997.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1107.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 960.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1033.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 775.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 775.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1144.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1033.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1033.94, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - 93307 - 48300011", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3370.28, "discounted_cash": 224, "minimum": 217.54, "maximum": 3114.1387, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 359.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 415.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 359.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 337.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 224.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 292.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 314.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 217.54 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 224.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 236.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 224.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 348.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 239.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 224.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1563 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 314.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 224.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1598 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 314.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.84 } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - C8923 - 48300011", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3370.28, "discounted_cash": 738, "minimum": 738.53, "maximum": 3114.1387, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1181.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1366.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1181.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 775.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 997.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1107.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 960.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1033.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 775.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 775.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1144.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1563 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1033.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 738.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1598 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1033.94, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp & Postprocess Supervision (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1182.37, "minimum": 19.78, "maximum": 1092.5099, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 140.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 55.01, "10th_percentile": 55.01, "90th_percentile": 55.01, "count": "1 through 10" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.69 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 111.69 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 21.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.5 } ] } ] }, { "description": "Hc 3D Rendering W/Interp&Postproc Diff Work Statio", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1247.43, "minimum": 45.81, "maximum": 1152.6253, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 181.44 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.23 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.23 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.4 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.9 } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2903.72, "discounted_cash": 854, "minimum": 260.47, "maximum": 2683.0373, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 334.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1367.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1580.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1367.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.68 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 897.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1153.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1281.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 578.94 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1110.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1196.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 265.68 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 897.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 897.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 871.11, "10th_percentile": 871.11, "90th_percentile": 871.11, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1324.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1442.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1196.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1196.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1486.98 } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2763.75, "discounted_cash": 854, "minimum": 260.47, "maximum": 2665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 334.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1367.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1580.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1367.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.68 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 897.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1153.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1281.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 383.2 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1110.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1196.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 265.68 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 897.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 897.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1324.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1442.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1196.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 854.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1196.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1486.98 } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19028.3, "discounted_cash": 7348, "minimum": 1019.39, "maximum": 17582.1492, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5151 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1067.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7348.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11757.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13594.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11757.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2467.7 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7715.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9920.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 11022.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 7348.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 9552.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10287.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7348.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2467.7 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7715.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7715.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 7348.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11389.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1019.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2419.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7348.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7348.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10287.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2419.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7348.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7348.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 10287.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1050.92 } ] } ] }, { "description": "Hc Ablate L/R Atrial Fibril W Isolated Pulm Vein", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16276.8, "minimum": 262.9, "maximum": 15039.7632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 337.34 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.16 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 268.16 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 734.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.9 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 757.03 } ] } ] }, { "description": "Hc Ablate Pulm Tumor Perq Crybl", "code_information": [ { "code": "32994", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6428.7, "discounted_cash": 10014, "minimum": 1928.61, "maximum": 6428.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 3095.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3095.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6428.7 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3095.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 6428.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3034.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6428.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3034.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6428.7 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6428.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6428.7 } ] } ] }, { "description": "Hc Ablate Renaltumor Cryo, Unilat Perq", "code_information": [ { "code": "50593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8069.02, "discounted_cash": 10014, "minimum": 185.03, "maximum": 8069.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5302 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 188.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.73 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8069.02 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 188.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 8069.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8069.02 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 8069.02 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 8069.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8069.02 } ] } ] }, { "description": "Hc Ablation 1/> Liver Tumor Perq Cryoablation", "code_information": [ { "code": "47383", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22129.7, "discounted_cash": 10014, "minimum": 2767.74, "maximum": 20447.8428, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5302 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 3551.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10014.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16023.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18526.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16023.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2823.09 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10515.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13519.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 15021.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 10014.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13445.31 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 13018.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14020.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10014.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2823.09 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10515.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10515.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 10014.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15522.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 8708.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2767.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10014.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10014.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14020.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2767.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10014.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10014.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 14020.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8977.36 } ] } ] }, { "description": "Hc Ablation Bone Tumor W/ Img Gdn When Prfmd", "code_information": [ { "code": "20983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17789.4, "discounted_cash": 6836, "minimum": 2488, "maximum": 16437.4056, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 3262.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12646.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10937.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2593.66 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9228.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10254.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11761.54 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8887.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2593.66 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7177.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10596.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10876.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2542.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9660 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2542.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6836.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 9870 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9570.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11212.84 } ] } ] }, { "description": "Hc Acetylcholine Receptor Binding Antibody", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.37, "discounted_cash": 18, "minimum": 15.64, "maximum": 95.5139, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 44.14, "10th_percentile": 44.14, "90th_percentile": 44.14, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Blckg Antb", "code_information": [ { "code": "86042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.37, "discounted_cash": 18, "minimum": 15.64, "maximum": 95.5139, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 44.14, "10th_percentile": 44.14, "90th_percentile": 44.14, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Modlg Antb", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.7, "discounted_cash": 12, "minimum": 10.24, "maximum": 62.5548, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 28.91, "10th_percentile": 28.91, "90th_percentile": 28.91, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.44 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.24 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acoustic Immitance Testing", "code_information": [ { "code": "92570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.79, "discounted_cash": 121, "minimum": 17.02, "maximum": 246.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 21.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 193.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 224.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 193.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 181.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 121.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 157.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.36 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 127.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 121.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 187.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 53.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 169.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 121.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.79 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 169.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.6 } ] } ] }, { "description": "Hc Acoustic Reflex Testing", "code_information": [ { "code": "92568", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.38, "discounted_cash": 35, "minimum": 10.0856, "maximum": 228.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 65.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 52.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 45.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 36.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 54.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.38 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.38 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 49.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.5 } ] } ] }, { "description": "Hc Actin Smooth Muscle Antibody Each", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.52, "discounted_cash": 12, "minimum": 7.49, "maximum": 29.1245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.49 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.05, "discounted_cash": 15, "minimum": 15.32, "maximum": 328.9902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 24.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.95 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 33.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.27 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.27 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39 } ] } ] }, { "description": "Hc Adm Sarscv2 30Mcg Trs-Sucr 1", "code_information": [ { "code": "0051A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.11, "minimum": 14.733, "maximum": 45.3776, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28 } ] } ] }, { "description": "Hc Adm Sarscv2 30Mcg Trs-Sucr 2", "code_information": [ { "code": "0052A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.11, "minimum": 14.733, "maximum": 45.3776, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28 } ] } ] }, { "description": "Hc Adm Sarscv2 30Mcg Trs-Sucr 3", "code_information": [ { "code": "0053A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.11, "minimum": 14.733, "maximum": 45.3776, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28 } ] } ] }, { "description": "Hc Adm Sarscv2 30Mcg Trs-Sucr B", "code_information": [ { "code": "0054A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.11, "minimum": 14.733, "maximum": 45.3776, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28 } ] } ] }, { "description": "Hc Admin Influenza Virus Vac - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.33, "discounted_cash": 44, "minimum": 6.999, "maximum": 23.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Pneumococcal Vac - G0009 - 77100009 - 77100009", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.99, "discounted_cash": 44, "minimum": 27, "maximum": 179.2468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 81.6, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 66.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 57.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 68.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 61.75, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aerosol Inhalation Treat For Pneum Carinii", "code_information": [ { "code": "94642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.73, "discounted_cash": 206, "minimum": 48.0415, "maximum": 235.73, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 48.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.47 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 70.47 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.09 } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Mult Step", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.78, "discounted_cash": 11, "minimum": 11.98, "maximum": 203.0767, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 31.99, "10th_percentile": 31.99, "90th_percentile": 31.99, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 25.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.6 } ] } ] }, { "description": "Hc Agent Nos Assay W/Optic", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.91, "discounted_cash": 16, "minimum": 14.25, "maximum": 119.1128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.28 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 28.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2 } ] } ] }, { "description": "Hc Agglutinins; Febrile", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.46, "discounted_cash": 6, "minimum": 5.93, "maximum": 231.425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 7.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.05 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.57 } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.78, "discounted_cash": 206, "minimum": 13.1396, "maximum": 219.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 87.91, "10th_percentile": 87.91, "90th_percentile": 87.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 134.07, "10th_percentile": 134.07, "90th_percentile": 135.6, "count": "20" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 93.85, "10th_percentile": 93.82, "90th_percentile": 93.85, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.47 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 70.47 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 31.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 206.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.78 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 219.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.38 } ] } ] }, { "description": "Hc Alkaloids Not Otherwise Specified - 80323 - 30080323", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.61, "minimum": 1, "maximum": 248.9441, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.1 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.1 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.86 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.02 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Alkaloids Not Otherwise Specified - G0480 - 30080323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.61, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.16, "discounted_cash": 7, "minimum": 7.97, "maximum": 89.7758, "payers_information": [ { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 16.99 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 13.15 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.15 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.49, "discounted_cash": 5, "minimum": 5.22, "maximum": 102.0928, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.6 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.68 } ] } ] }, { "description": "Hc Allergen Spec Ige Recombinant/Purified Compnt Ea", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.47, "discounted_cash": 17, "minimum": 17.93, "maximum": 190.7783, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 19.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 125.95, "10th_percentile": 125.95, "90th_percentile": 125.95, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 39.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.57 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.57 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.23 } ] } ] }, { "description": "Hc Allergen Specific Igg", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.25, "discounted_cash": 7, "minimum": 6.65, "maximum": 51.051, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.6 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.28 } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 567.24, "discounted_cash": 14, "minimum": 13.65, "maximum": 524.1298, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 18.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.92 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.65 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 23.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.65 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.86 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.45 } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.81, "discounted_cash": 13, "minimum": 13.44, "maximum": 188.3204, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 18.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.71 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.87 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.71 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 28.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.16 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.85 } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1503.32, "discounted_cash": 64, "minimum": 64.41, "maximum": 1389.0677, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 81.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 154.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 103.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.7 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.07 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 83.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 65.7 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 139.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 106.25 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% 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": 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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.25 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.41 } ] } ] }, { "description": "Hc Alpha-Fetoprotein, Serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 428.49, "discounted_cash": 16, "minimum": 14.25, "maximum": 395.9248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 18.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 44.77, "10th_percentile": 44.77, "90th_percentile": 44.77, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.54 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.88 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.54 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 36.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.67 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.67 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.64 } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation - 82131 - 30100060", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1543.33, "discounted_cash": 22, "minimum": 19.81, "maximum": 1426.0369, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 26.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.21 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.38 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 40.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.53 } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation - 82136 - 30100060", "code_information": [ { "code": "82136", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1543.33, "discounted_cash": 19, "minimum": 18.13, "maximum": 1426.0369, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.88 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 36.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.64 } ] } ] }, { "description": "Hc Amniocentesis,Diagnostic", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1647.7, "discounted_cash": 867, "minimum": 248.81, "maximum": 1647.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1647.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1388.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1605.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1388.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.64 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 911.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1171.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.81 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1128.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1214.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 265.64 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 911.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 911.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1344.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1116.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1647.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1214.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 867.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1647.7 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1214.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1151.2 } ] } ] }, { "description": "Hc Amniocentesis,Ther Amniotic Fluid Reduct", "code_information": [ { "code": "59001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3192.25, "discounted_cash": 287, "minimum": 257.4, "maximum": 2949.639, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 459.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 531.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 459.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 387.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 430.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 357.01 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 373.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 301.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 444.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 520.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 401.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 287.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 401.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 536.7 } ] } ] }, { "description": "Hc Analysis, Tumor", "code_information": [ { "code": "88358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.41, "discounted_cash": 160, "minimum": 45.72, "maximum": 310.8428, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 59.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 256.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 296.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 256.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.23 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 216.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 240.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.67 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 208.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 70.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 168.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 248.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 83.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 224.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 160.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.72 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.3 } ] } ] }, { "description": "Hc Analyze Neurostim,Complx/Prog", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 892.59, "discounted_cash": 89, "minimum": 89.56, "maximum": 892.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 165.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 120.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 134.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 89.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 116.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 89.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 94.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 89.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 138.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 98.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 892.59 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 125.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 89.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 892.59 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 125.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 102.04 } ] } ] }, { "description": "Hc Anesth Vag Delivery, Epidural", "code_information": [ { "code": "01967", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1326.73, "minimum": 275, "maximum": 1225.8985, "payers_information": [ { "payer_name": "Early Detection Works", "plan_name": "Early Detection Works Program", "methodology": "fee schedule", "standard_charge_dollar": 275 } ] } ] }, { "description": "Hc Angio Aortobifemoral W Cath", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15299.5, "discounted_cash": 2974, "minimum": 120.77, "maximum": 14136.738, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 443.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.77 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 130.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 134.19 } ] } ] }, { "description": "Hc Angio Aortogram Abd Serial", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15299.5, "discounted_cash": 2974, "minimum": 112.64, "maximum": 14136.738, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 615.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 9332.68, "10th_percentile": 9332.68, "90th_percentile": 9332.68, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 119.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 128.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 132.45 } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17088.4, "discounted_cash": 5242, "minimum": 120.77, "maximum": 15789.6816, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4368.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 134.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 320.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12984.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9698.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4456.18 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7077.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7863.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.77 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6815.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4456.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8125.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 130.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Ea Addnl Selectv Vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3574.1, "minimum": 96.38, "maximum": 3302.4684, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 513.78 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 408.41 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 102.03 }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 408.41 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 109.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.4 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 113.37 } ] } ] }, { "description": "Hc Angio Extermity Bilat - 75716 - 32300007", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13076, "discounted_cash": 2974, "minimum": 134.54, "maximum": 12082.224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 625.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.23 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 156.53 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 161.37 } ] } ] }, { "description": "Hc Angio Extermity Bilat - G0278 - 32300007", "code_information": [ { "code": "G0278", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13076, "minimum": 678.477, "maximum": 12082.224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3131 } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10314.7, "discounted_cash": 2974, "minimum": 125.97, "maximum": 13204.1448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 615.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 6291.94, "10th_percentile": 6291.94, "90th_percentile": 6291.94, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.97 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 135.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.97 } ] } ] }, { "description": "Hc Angio Intern Mammary", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10314.7, "discounted_cash": 2974, "minimum": 169.7, "maximum": 9530.7828, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 200.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 169.7 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 182.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1323.12 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1323.12 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 188.56 } ] } ] }, { "description": "Hc Angio Pelvis", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17088.4, "discounted_cash": 5242, "minimum": 154.09, "maximum": 15789.6816, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 320.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12984.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9698.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4456.18 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7077.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7863.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 154.09 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6815.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4456.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8125.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 166.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4368.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.21 } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5057.27, "discounted_cash": 2974, "minimum": 141.08, "maximum": 5057.27, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1323.12 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1323.12 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 156.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 212.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5057.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5057.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 141.08 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 152.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Select", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14290.2, "discounted_cash": 2974, "minimum": 129.1, "maximum": 13204.1448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 337.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.1 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 139.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.44 } ] } ] }, { "description": "Hc Angio Pulmon Unilat Select", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14290.2, "discounted_cash": 2974, "minimum": 127.54, "maximum": 13204.1448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 325.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 127.54 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 137.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 141.71 } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14290.2, "discounted_cash": 2974, "minimum": 125.97, "maximum": 13204.1448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 615.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 6291.94, "10th_percentile": 6291.94, "90th_percentile": 6291.94, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.97 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 135.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.97 } ] } ] }, { "description": "Hc Angio Spinal Selectv", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14290.2, "discounted_cash": 5242, "minimum": 202.5, "maximum": 13204.1448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 354.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12984.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9698.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4456.18 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7077.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7863.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.5 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6815.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4456.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8125.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 218.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7221.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4368.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7221.79 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 225 } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17088.4, "discounted_cash": 5242, "minimum": 137.95, "maximum": 15789.6816, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 334.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12984.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9698.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8387.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4456.18 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7077.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7863.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137.95 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6815.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4456.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5504.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8125.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 148.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7221.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4368.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5242.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7221.79 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7339.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.28 } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10314.7, "discounted_cash": 2974, "minimum": 125.97, "maximum": 13204.1448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 615.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 6291.94, "10th_percentile": 6291.94, "90th_percentile": 6291.94, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5503.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4759.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4462.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.97 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4610.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 135.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4122.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.97 } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - G0278 - 32300016", "code_information": [ { "code": "G0278", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10314.7, "minimum": 678.477, "maximum": 12082.224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3131 } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.41, "discounted_cash": 14, "minimum": 14.6, "maximum": 310.8428, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 38.96, "10th_percentile": 38.96, "90th_percentile": 38.96, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 24.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.08 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.45 } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4270.24, "discounted_cash": 2974, "minimum": 65.59, "maximum": 4270.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4270.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 159.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4270.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 4270.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4270.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4270.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4015.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 4270.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.59 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 3867.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2582.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3123.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4270.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 70.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1323.12 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2532.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2974.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1323.12 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 4164.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.88 } ] } ] }, { "description": "Hc Anorectal Manometry", "code_information": [ { "code": "91122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1971.83, "discounted_cash": 287, "minimum": 113.4313, "maximum": 1821.9709, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 113.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 459.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 531.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 459.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 387.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 430.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 373.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 402.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 301.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 445.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 388.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 402.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 402.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 400.21 } ] } ] }, { "description": "Hc Anoscopy W Remove Foreign Body", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4808.85, "discounted_cash": 876, "minimum": 472.11, "maximum": 4443.3774, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 876.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1401.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1620.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1401.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 919.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1182.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1314.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 876.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 472.11 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 1138.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1226.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 876.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 919.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 919.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 876.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1357.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1377.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 876.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 876.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1226.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 876.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 876.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 1226.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1419.96 } ] } ] }, { "description": "Hc Antb Severe Aqt Respir Synd Sars-Cov-2 Covid19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.39, "discounted_cash": 42, "minimum": 26.517, "maximum": 88.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 36.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 67.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.53 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 63.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 54.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.53 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.56 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antegrade Urography Radiological Supvj & Interpj", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1507.72, "discounted_cash": 328, "minimum": 40.843, "maximum": 1393.1333, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 857.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 608.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 443.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 493.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.27 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 427.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 509.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 75.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 412.16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 412.16 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.08 } ] } ] }, { "description": "Hc Anterior Colporraphy Rpr Cystocele W/Cysto", "code_information": [ { "code": "57240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26841.4, "discounted_cash": 4712, "minimum": 600.5189, "maximum": 24801.4536, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7540.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8718.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7540.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1643.52 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4948.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6362.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7069.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.83 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6126.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6598, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1643.52 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4948.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4948.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7304.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 7976.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1611.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6598, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1611.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6598, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8223.62 } ] } ] }, { "description": "Hc Antibiotic Sens, Mlc, Each", "code_information": [ { "code": "87187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.79, "discounted_cash": 40, "minimum": 9.2, "maximum": 138.406, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 11.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 60.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.41 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 52.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 62.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 70.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.68 } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.39, "discounted_cash": 4, "minimum": 4.75, "maximum": 81.6724, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38 } ] } ] }, { "description": "Hc Antibiotic Sens,Enzyme Detection,Each", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.92, "discounted_cash": 4, "minimum": 4.75, "maximum": 29.4941, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38 } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.48, "discounted_cash": 8, "minimum": 8.65, "maximum": 52.1875, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.26 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 34.45, "10th_percentile": 23.08, "90th_percentile": 34.85, "count": "41" } ] } ] }, { "description": "Hc Antibody John Cunningham Virus", "code_information": [ { "code": "86711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.89, "discounted_cash": 16, "minimum": 16.89, "maximum": 87.6784, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 25.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.62 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 30.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.75 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.8 } ] } ] }, { "description": "Hc Antibody Treponema Pallidum", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1086.6, "discounted_cash": 13, "minimum": 13.24, "maximum": 1004.0184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 21.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.28 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 28.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2 } ] } ] }, { "description": "Hc Antidepressants Serotonergic Class 1 Or 2 - 80332 - 31080332", "code_information": [ { "code": "80332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703.53, "minimum": 1, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.42 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.32 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Antidepressants Serotonergic Class 1 Or 2 - G0480 - 31080332", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703.53, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.23, "discounted_cash": 55, "minimum": 5.39, "maximum": 313.0789, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 14.39, "10th_percentile": 14.39, "90th_percentile": 14.39, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 98.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 83.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 72.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 58.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 86.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.68 } ] } ] }, { "description": "Hc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.76, "discounted_cash": 160, "minimum": 5.18, "maximum": 95.76, "payers_information": [ { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.28 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Titer Ea Antb", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.16, "discounted_cash": 12, "minimum": 7.83, "maximum": 40.8038, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.78, "discounted_cash": 12, "minimum": 12.09, "maximum": 203.0767, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 22.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 32.26, "10th_percentile": 12.09, "90th_percentile": 83.52, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.33 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.33 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 25.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.94 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.6 } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.5, "discounted_cash": 11, "minimum": 11.16, "maximum": 61.446, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 20.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.19 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 23.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 18.42 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.42 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.66 } ] } ] }, { "description": "Hc Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.49, "discounted_cash": 7, "minimum": 7.3, "maximum": 370.9768, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 15.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.22 } ] } ] }, { "description": "Hc Antithrombin Iii Test,Activ", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.54, "discounted_cash": 11, "minimum": 11.85, "maximum": 87.355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 21.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 25.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.6 } ] } ] }, { "description": "Hc Antithrombin Iii Test,Antigen", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.16, "discounted_cash": 10, "minimum": 10.81, "maximum": 43.5758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.61 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 23.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.83 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.83 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.01 } ] } ] }, { "description": "Hc Aortic Dys/Dilat Genom Seq Ana", "code_information": [ { "code": "81410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16390.4, "discounted_cash": 504, "minimum": 504, "maximum": 15144.7296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 876.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1210.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 806.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 680.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 756, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 817.61 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 655.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 781.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 881.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 604.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 604.8 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 908.46 } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8229.86, "discounted_cash": 1943, "minimum": 235, "maximum": 7604.3906, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 301.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3110.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3596.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3110.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 239.7 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2041.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2624.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2915.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 647.87 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2526.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2721.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 239.7 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2041.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2041.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3012.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 3042.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2721.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2721.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3136.86 } ] } ] }, { "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": 1755.74, "minimum": 153.99, "maximum": 1662, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 197.59 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.07 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.48 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 157.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8229.86, "discounted_cash": 696, "minimum": 153.99, "maximum": 7604.3906, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 197.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1114.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1288.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1114.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.07 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 939.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1044.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 293.61 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 905.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 974.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 157.07 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 731.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 3042.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 974.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 974.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3136.86 } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm Ea Ad 25Cm", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1755.74, "minimum": 56.48, "maximum": 1662, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 72.47 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.48 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13460.2, "discounted_cash": 1943, "minimum": 235, "maximum": 12437.2248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 301.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3110.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3596.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3110.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 239.7 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2041.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2624.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 2915.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 592.04 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 2526.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2721.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 239.7 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2041.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2041.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3012.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 5258.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6239 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2721.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1943.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6375 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 2721.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5420.96 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm Ea Add 100Sqcm", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2925.81, "minimum": 139.91, "maximum": 2703.4484, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 197.59 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.07 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 157.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 } ] } ] }, { "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": 8229.86, "discounted_cash": 696, "minimum": 153.99, "maximum": 7604.3906, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 197.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1114.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1288.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1114.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.07 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 939.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1044.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 277.76 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 905.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 974.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 157.07 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 731.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 731.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1079.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 3042.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2608 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 974.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 2665 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 974.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3136.86 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm Ea Ad 25Qsqcm", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1755.74, "minimum": 53.76, "maximum": 1662, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 72.47 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.48 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 } ] } ] }, { "description": "Hc Appl Multlay Comprs Arm/Hand", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 859.98, "discounted_cash": 153, "minimum": 53.32, "maximum": 794.6215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 68.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 283.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.39 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 229.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 155.08 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 199.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.39 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 237.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 262.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.84 } ] } ] }, { "description": "Hc Application Cast Finger", "code_information": [ { "code": "29086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 631.08, "discounted_cash": 153, "minimum": 153.09, "maximum": 631.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 631.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 283.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 229.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 157.83 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 199.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 237.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 262.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.84 } ] } ] }, { "description": "Hc Application Of Finger Splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.64, "discounted_cash": 55, "minimum": 10.6759, "maximum": 337.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 102.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.22 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 83.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.38 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 72.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.22 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 58.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 86.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 108.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 337.64 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 337.64 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.92 } ] } ] }, { "description": "Hc Apply Elbow To Finger Cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1248.67, "discounted_cash": 263, "minimum": 171.61, "maximum": 1153.7711, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 487.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 355.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 395.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.61 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 342.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 408.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 460.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.56 } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.65, "discounted_cash": 125, "minimum": 17.9257, "maximum": 364.65, "payers_information": [ { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 131.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 194.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 108.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 364.65 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 364.65 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 175.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 231.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.21 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 169.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 188.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.02 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 162.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.48, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.88, "discounted_cash": 125, "minimum": 125.34, "maximum": 462.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 231.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 169.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 188.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 152.32 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 162.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 131.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 194.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 203.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 462.88 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 462.88 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 175.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210.08 } ] } ] }, { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 693.7, "discounted_cash": 125, "minimum": 125.34, "maximum": 640.9788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 231.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 169.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 188.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 128.2 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 162.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 131.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 194.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 203.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 125.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 175.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210.08 } ] } ] }, { "description": "Hc Apply Long Arm Cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1248.67, "discounted_cash": 263, "minimum": 190.22, "maximum": 1153.7711, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 487.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 355.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 395.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 190.22 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 342.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 408.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 460.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.56 } ] } ] }, { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 876.63, "discounted_cash": 153, "minimum": 153.09, "maximum": 810.0061, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 283.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 229.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 173.68 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 199.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 237.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 262.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.84 } ] } ] }, { "description": "Hc Apply Long Leg Cast", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1248.67, "discounted_cash": 263, "minimum": 228.8, "maximum": 1248.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1248.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 487.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 355.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 395.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 268.79 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 342.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 408.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 460.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.56 } ] } ] }, { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 876.63, "discounted_cash": 153, "minimum": 153.09, "maximum": 810.0061, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 283.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 229.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 168.17 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 199.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 237.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 262.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 876.63, "discounted_cash": 153, "minimum": 141.98, "maximum": 810.0061, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 283.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 229.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 141.98 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 199.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 212.16 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 237.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 262.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.84 } ] } ] }, { "description": "Hc Apply Multlay Comprs Lwr Leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 585.65, "discounted_cash": 153, "minimum": 38.17, "maximum": 585.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 292.83, "10th_percentile": 292.83, "90th_percentile": 439.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 48.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 250.07, "10th_percentile": 56.27, "90th_percentile": 277.56, "count": "47" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 250.07, "10th_percentile": 250.07, "90th_percentile": 250.07, "count": "12" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 283.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.93 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 229.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 166.79 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 199.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.93 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 237.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 262.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 585.65 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 153.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 585.65 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 214.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.84 } ] } ] }, { "description": "Hc Apply Rigid Leg Cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 805.43, "discounted_cash": 263, "minimum": 228.8, "maximum": 744.2173, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 487.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 355.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 395.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 257.77 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 342.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 241.63, "10th_percentile": 241.63, "90th_percentile": 241.63, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 408.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 460.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.56 } ] } ] }, { "description": "Hc Apply Short Leg Cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1248.67, "discounted_cash": 263, "minimum": 160.59, "maximum": 1153.7711, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 266.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 487.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 355.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 395.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.59 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 342.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.38 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 276.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 408.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 460.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 263.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 368.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.56 } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.36, "discounted_cash": 12, "minimum": 4.308, "maximum": 14.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antibody Flow Cytometry Each", "code_information": [ { "code": "86053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.33, "discounted_cash": 37, "minimum": 7.83, "maximum": 201.7369, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 56.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 49.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 58.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquatic Therapy/Exercises Ea 15 Min", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.45, "discounted_cash": 34, "minimum": 27.9472, "maximum": 271.1478, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 27.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 64.6 }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.55 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 52.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 368.34, "10th_percentile": 264.11, "90th_percentile": 1320.53, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 54.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 48.89, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.83, "discounted_cash": 55, "minimum": 5.39, "maximum": 313.0789, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 14.39, "10th_percentile": 14.39, "90th_percentile": 14.39, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 102.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 88.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 83.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 72.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 58.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 86.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.68 } ] } ] }, { "description": "Hc Arc Rbc Antibody Identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1772.85, "discounted_cash": 337, "minimum": 10.0086, "maximum": 1638.1134, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 540.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 624.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 540.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.89 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 354.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 455.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 506.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 337.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.17 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 439, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 472.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 337.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 257.89 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 354.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 354.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 337.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 523.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 79.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 337.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 337.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.16 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 472.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.41 } ] } ] }, { "description": "Hc Arterial Line Insertion", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1254.81, "minimum": 87.53, "maximum": 1254.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1254.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 238.68 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.53 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 238.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 234 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 234 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 } ] } ] }, { "description": "Hc Arthro Hip Wo Anesth", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1264.62, "minimum": 83.82, "maximum": 1264.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1264.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 107.55 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 367.35 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 912, "10th_percentile": 912, "90th_percentile": 912, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.82 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/Us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2951.59, "discounted_cash": 665, "minimum": 142.73, "maximum": 2727.2692, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 183.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 665.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1064.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1230.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1064.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.58 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 897.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 997.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 665.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 157.14 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 864.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 931.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 665.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 145.58 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 698.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 665.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1030.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1054.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 665.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 665.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 931.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 665.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 665.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 931.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1086.76 } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3698.1, "discounted_cash": 289, "minimum": 142.73, "maximum": 3417.0444, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 183.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.58 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 433.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.82 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 375.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 145.58 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 448.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 474.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 489.4 } ] } ] }, { "description": "Hc Arthrocnt Aspir&/Inj Small Jt/Bursaw/Us Rec Rprt", "code_information": [ { "code": "20604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2104.43, "discounted_cash": 289, "minimum": 141.29, "maximum": 1944.4933, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 183.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.58 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 433.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 141.29 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 375.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 145.58 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 448.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 474.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 489.4 } ] } ] }, { "description": "Hc Arthrogram Of Ankle", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1718.91, "discounted_cash": 328, "minimum": 92.0796, "maximum": 1588.2728, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 857.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 608.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 443.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 493.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 114.53 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 427.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 509.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 123.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 127.25 } ] } ] }, { "description": "Hc Arthrogram Of Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1754.51, "discounted_cash": 328, "minimum": 92.0796, "maximum": 1621.1672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 857.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 608.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 443.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 493.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.39 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 427.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 509.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 106.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.32 } ] } ] }, { "description": "Hc Arthrogram Of Hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1775.37, "discounted_cash": 328, "minimum": 92.0796, "maximum": 1640.4419, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 857.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 608.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 443.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 493.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.8 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 427.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 509.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 117.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.89 } ] } ] }, { "description": "Hc Arthrogram Of Knee Joint", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2455.57, "discounted_cash": 328, "minimum": 92.0796, "maximum": 2268.9467, "payers_information": [ { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 443.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 493.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.62 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 427.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 509.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 139.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 144.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 857.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 608.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.43 } ] } ] }, { "description": "Hc Arthrogram Of Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2354.9, "discounted_cash": 328, "minimum": 92.0796, "maximum": 2175.9276, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 857.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 608.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 443.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 493.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.28 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 427.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 509.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 116.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.31 } ] } ] }, { "description": "Hc Arthrogram Of Wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1775.37, "discounted_cash": 328, "minimum": 92.0796, "maximum": 1640.4419, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 857.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 608.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 525.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 443.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 493.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 115.05 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 427.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "First Health", "plan_name": "First Health", "methodology": "fee schedule", "standard_charge_dollar": 750 }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 345.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 509.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 124 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 460.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 127.83 } ] } ] }, { "description": "Hc Arthroplasty Glenohumeral Joint Total Shoulder", "code_information": [ { "code": "23472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75057.7, "discounted_cash": 16518, "minimum": 2895.42, "maximum": 69353.3148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16518.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26430.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 30559.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26430.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8981.15 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17344.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22300.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 24778.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16518.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2895.42 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 21474.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23126.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16518.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8981.15 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17344.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17344.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16518.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25604.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8805.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16518.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16518.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10616 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23126.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8805.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16518.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16518.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10848 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23126.35, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthroplasty Glenohumrl Jt Hemiarthroplasty", "code_information": [ { "code": "23470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75057.7, "discounted_cash": 12095, "minimum": 600.5189, "maximum": 69353.3148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 600.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19352.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 22376.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19352.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12700.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16328.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18143.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2383.33 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15724.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16933.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4348.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12700.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12700.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18747.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 19638.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10616 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16933.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4263.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12095.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 10848 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16933.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20245.84 } ] } ] }, { "description": "Hc Asp/Drain Large Joint/Bursa", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1954.64, "discounted_cash": 289, "minimum": 118.55, "maximum": 6057.8826, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 448.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 474.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 300.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 894.98, "10th_percentile": 795.54, "90th_percentile": 1341.38, "count": "20" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.7, "median_amount": 795.54, "10th_percentile": 513.73, "90th_percentile": 795.54, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 433.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.55 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 375.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 262.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Ag Eia", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.31, "discounted_cash": 11, "minimum": 11.98, "maximum": 318.1424, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 25.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.6 } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 443.23, "discounted_cash": 15, "minimum": 10.0086, "maximum": 409.5445, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.37 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 32.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.74 } ] } ] }, { "description": "Hc Aspirat/Injection Ganglion Cyst(S)", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1289.18, "discounted_cash": 289, "minimum": 118.55, "maximum": 1289.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1289.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 224.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 462.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 196.03 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 433.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.55 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 375.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 196.03 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 303.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 448.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 474.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 192.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 611 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 192.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 289.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 624 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 404.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 489.4 } ] } ] }, { "description": "Hc Aspiration And/Or Injection Thyroid Cyst", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2262.81, "discounted_cash": 667, "minimum": 186.31, "maximum": 2090.8364, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 190.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1067.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1234.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1067.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 900.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 1000.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.58 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 867.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 933.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 190.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 700.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1034.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 1111.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1743 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 933.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 667.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 1781 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 933.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1145.7 } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.05, "discounted_cash": 5, "minimum": 5.18, "maximum": 124.7862, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.28 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.68 } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase ,Isoenzymes", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 854.54, "discounted_cash": 14, "minimum": 14.78, "maximum": 789.595, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 27.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.78 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 32.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.09 } ] } ] }, { "description": "Hc Assay Biovlbl Testosterone Direct Measurement", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.12, "discounted_cash": 51, "minimum": 51.28, "maximum": 159.9629, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 82.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.31 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 76.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 102.79 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 66.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.31 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 53.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 79.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 110.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 87.06 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.28 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.06 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 114.21 } ] } ] }, { "description": "Hc Assay Blood Carbon Monoxide", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.77, "discounted_cash": 12, "minimum": 12.32, "maximum": 292.6955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 20.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.53 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 26.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.25 } ] } ] }, { "description": "Hc Assay For Calprotectin Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 543.86, "discounted_cash": 19, "minimum": 19.63, "maximum": 502.5266, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 24.71 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.02 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 25.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 163.16, "10th_percentile": 163.16, "90th_percentile": 163.16, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 32.38 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.38 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay For Phencyclidine", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221, "discounted_cash": 20, "minimum": 1, "maximum": 204.204, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 37, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.08 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 75.53 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.24 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.87 } ] } ] }, { "description": "Hc Assay Glucose, Body Fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.42, "discounted_cash": 3, "minimum": 3.93, "maximum": 131.5961, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 86.88, "10th_percentile": 86.88, "90th_percentile": 86.88, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.01 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.01 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.44 } ] } ] }, { "description": "Hc Assay Growth Hormone (Hgh)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.26, "discounted_cash": 16, "minimum": 16.67, "maximum": 280.2122, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 28.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 25.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.29 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 35.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.52 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.52 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.99 } ] } ] }, { "description": "Hc Assay Lipoprotein Pla2", "code_information": [ { "code": "83698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2056.55, "discounted_cash": 46, "minimum": 40.82, "maximum": 1900.2522, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 43.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.64 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 69.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.34 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 60.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.64 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 48.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 71.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 81.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.99 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.71 } ] } ] }, { "description": "Hc Assay Myeloperoxidase", "code_information": [ { "code": "83876", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.48, "discounted_cash": 50, "minimum": 21.4416, "maximum": 851.9927, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 21.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.09 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 76.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.34 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 66.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.09 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 78.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 88.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.99 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.99 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 91.49 } ] } ] }, { "description": "Hc Assay Of 17-Hydroxypregneno", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.14, "discounted_cash": 22, "minimum": 22.81, "maximum": 118.4014, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 35.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.27 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 34.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.55 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.27 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 49.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.64 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.64 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.61 } ] } ] }, { "description": "Hc Assay Of 5-Hiaa", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.02, "discounted_cash": 12, "minimum": 12.9, "maximum": 547.9505, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 18.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.16 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.16 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 27.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.55 } ] } ] }, { "description": "Hc Assay Of Acetaminophen - 80329 - 30100036", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 365.88, "minimum": 1, "maximum": 338.0731, "payers_information": [ { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.24 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.24 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.78 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.05 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 163.27, "10th_percentile": 163.27, "90th_percentile": 223.19, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 163.27, "10th_percentile": 163.27, "90th_percentile": 223.19, "count": "1 through 10" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - G0480 - 30100036", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 365.88, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acth", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.61, "discounted_cash": 38, "minimum": 32.83, "maximum": 645.5156, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 35.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 426.15, "10th_percentile": 426.15, "90th_percentile": 426.15, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.49 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.09 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.49 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 83.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.72 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.65 } ] } ] }, { "description": "Hc Assay Of Alcohol (Ethanol) Breath", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.76, "discounted_cash": 30, "minimum": 1, "maximum": 88.4822, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.47 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 52.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.86 } ] } ] }, { "description": "Hc Assay Of Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.73, "discounted_cash": 9, "minimum": 9.71, "maximum": 307.4425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 20.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.01 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.01 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.41 } ] } ] }, { "description": "Hc Assay Of Aldosterone", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 876.63, "discounted_cash": 40, "minimum": 34.64, "maximum": 810.0061, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 40.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.77 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 52.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 88.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.22 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 90.85 } ] } ] }, { "description": "Hc Assay Of Amikacin", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.61, "discounted_cash": 15, "minimum": 12.82, "maximum": 645.5156, "payers_information": [ { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 32.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.82 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 24.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.82 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.86 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.37 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amitriptyline - 80335 - 30100408", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.84, "minimum": 1, "maximum": 265.4652, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.42 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Amitriptyline - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.84, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.66, "discounted_cash": 14, "minimum": 12.38, "maximum": 247.3178, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.04 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.45 } ] } ] }, { "description": "Hc Assay Of Amphetamines - 80324 - 30100323", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221, "minimum": 1, "maximum": 204.204, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.69 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.69 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.38 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Amphetamines - G0480 - 30100323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.81, "discounted_cash": 6, "minimum": 6.48, "maximum": 188.3204, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.69 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.69 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.28 } ] } ] }, { "description": "Hc Assay Of Androstenedione", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.51, "discounted_cash": 29, "minimum": 13.4475, "maximum": 161.2472, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.39 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.4 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 38.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.39 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 62.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.29 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.29 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.89 } ] } ] }, { "description": "Hc Assay Of Androsterone", "code_information": [ { "code": "82160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1872.87, "discounted_cash": 25, "minimum": 13.4475, "maximum": 1730.5319, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.55 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.15 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 38.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.23 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.15 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 54.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.24 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.81 } ] } ] }, { "description": "Hc Assay Of Apolipoprotein", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.89, "discounted_cash": 21, "minimum": 11.667, "maximum": 38.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.46 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 37.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.56 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.29 } ] } ] }, { "description": "Hc Assay Of Arsenic", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.29, "discounted_cash": 18, "minimum": 11.9206, "maximum": 240.508, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 158.78, "10th_percentile": 158.78, "90th_percentile": 158.78, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.96 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 40.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.18 } ] } ] }, { "description": "Hc Assay Of Ascorbic Acid", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.04, "discounted_cash": 9, "minimum": 9.89, "maximum": 60.097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.85 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.31 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.06 } ] } ] }, { "description": "Hc Assay Of Barbiturates - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.12, "minimum": 1, "maximum": 159.9629, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Barbiturates - G0480 - 30100326", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.12, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 173.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 173.12, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - 80346 - 30100410", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.87, "minimum": 1, "maximum": 313.1159, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.42 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.33 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.87, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.09, "discounted_cash": 4, "minimum": 4.2, "maximum": 85.0912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.58 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.58 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38 } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Ldl Cholest", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.58, "discounted_cash": 10, "minimum": 10.5, "maximum": 162.2359, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 107.1, "10th_percentile": 25.46, "90th_percentile": 107.1, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.71 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.71 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 20.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.73 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.73 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.41 } ] } ] }, { "description": "Hc Assay Of Blood Osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.43, "discounted_cash": 6, "minimum": 6.46, "maximum": 156.5533, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 17.65, "10th_percentile": 17.65, "90th_percentile": 17.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.92 } ] } ] }, { "description": "Hc Assay Of Blood Pku", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.78, "discounted_cash": 5, "minimum": 4.68, "maximum": 203.0767, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.77 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.77 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 11.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.33 } ] } ] }, { "description": "Hc Assay Of C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.6, "discounted_cash": 20, "minimum": 17.69, "maximum": 237.0984, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.33 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.69 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.33 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 22.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.46 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 27.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 44.69 } ] } ] }, { "description": "Hc Assay Of Cadmium", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.2, "discounted_cash": 23, "minimum": 10.2781, "maximum": 269.9928, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.49 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 35.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.13 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.49 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 36.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 49.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.17 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.17 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.26 } ] } ] }, { "description": "Hc Assay Of Calcitonin", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 822.61, "discounted_cash": 26, "minimum": 13.4475, "maximum": 760.0916, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 40.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.73 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 34.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 57.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.18 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.7 } ] } ] }, { "description": "Hc Assay Of Calcium In Urine", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.84, "discounted_cash": 6, "minimum": 6.03, "maximum": 123.6682, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.27 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 246.05, "10th_percentile": 246.05, "90th_percentile": 246.05, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 13.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63 } ] } ] }, { "description": "Hc Assay Of Calcium, Ionized", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249.24, "discounted_cash": 13, "minimum": 8.4047, "maximum": 230.2978, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.86 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.45 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.86 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 29.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.55 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.5 } ] } ] }, { "description": "Hc Assay Of Calcium, Total", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.87, "discounted_cash": 5, "minimum": 5.16, "maximum": 108.9119, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 5.16, "10th_percentile": 5.16, "90th_percentile": 5.16, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.68 } ] } ] }, { "description": "Hc Assay Of Carbamazepine Total", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 295.9, "discounted_cash": 14, "minimum": 14.57, "maximum": 273.4116, "payers_information": [ { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.02 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.02 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carnitine", "code_information": [ { "code": "82379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.73, "discounted_cash": 16, "minimum": 16.87, "maximum": 106.9345, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.21 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.88 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 36.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.64 } ] } ] }, { "description": "Hc Assay Of Carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.32, "discounted_cash": 9, "minimum": 9.22, "maximum": 494.6357, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.76 } ] } ] }, { "description": "Hc Assay Of Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.38, "discounted_cash": 10, "minimum": 9.6, "maximum": 325.5991, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 12.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.79 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.61 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.79 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 23.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.71 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.01 } ] } ] }, { "description": "Hc Assay Of Chromium", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.35, "discounted_cash": 20, "minimum": 10.2781, "maximum": 108.4314, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.58 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.88 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 26.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.58 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 31.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 44.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.46 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.46 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.42 } ] } ] }, { "description": "Hc Assay Of Citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 471.48, "discounted_cash": 27, "minimum": 13.4475, "maximum": 435.6475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.49 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 43.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 59.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.63 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 45.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.63 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.86 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.65 } ] } ] }, { "description": "Hc Assay Of Ck (Cpk)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.98, "discounted_cash": 6, "minimum": 6.51, "maximum": 154.2895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 11.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 101.86, "10th_percentile": 17.37, "90th_percentile": 101.86, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.64 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.64 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.28 } ] } ] }, { "description": "Hc Assay Of Cocaine - 80353 - 30100327", "code_information": [ { "code": "80353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.55, "minimum": 1, "maximum": 201.9402, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 12.81 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.98 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Cocaine - G0480 - 30100327", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.55, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Copper", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520.58, "discounted_cash": 12, "minimum": 12.41, "maximum": 481.0159, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 27.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.47 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.9 } ] } ] }, { "description": "Hc Assay Of Cpk In Blood", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.62, "discounted_cash": 13, "minimum": 10.086, "maximum": 32.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 24.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.66 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.87 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 17.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.66 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 28.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.1 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.85 } ] } ] }, { "description": "Hc Assay Of Creatine", "code_information": [ { "code": "82540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.07, "discounted_cash": 4, "minimum": 4.64, "maximum": 21.3167, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.73 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38 } ] } ] }, { "description": "Hc Assay Of Creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.95, "discounted_cash": 5, "minimum": 5.12, "maximum": 104.3658, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 9.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 13.67, "10th_percentile": 13.67, "90th_percentile": 68.9, "count": "17" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 33.89, "10th_percentile": 33.89, "90th_percentile": 44.2, "count": "1 through 10" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.68 } ] } ] }, { "description": "Hc Assay Of Cryoglobulin", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.54, "discounted_cash": 6, "minimum": 6.47, "maximum": 291.559, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.28 } ] } ] }, { "description": "Hc Assay Of Cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 476.39, "discounted_cash": 18, "minimum": 14.782, "maximum": 440.1844, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 23.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 39.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.34 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 29.77 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.34 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.77 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.23 } ] } ] }, { "description": "Hc Assay Of Desipramine - 80335 - 30100403", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.8, "minimum": 1, "maximum": 265.4652, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.42 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Desipramine - G0480 - 30100403", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.8, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Digoxin", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.88, "discounted_cash": 13, "minimum": 13.28, "maximum": 223.4971, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 24.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 147.55, "10th_percentile": 147.55, "90th_percentile": 147.55, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.55 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.87 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 28.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.85 } ] } ] }, { "description": "Hc Assay Of Doxepin - 80335 - 30100409", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.3, "minimum": 1, "maximum": 265.4652, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.42 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Doxepin - G0480 - 30100409", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.3, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.1, "discounted_cash": 18, "minimum": 18.79, "maximum": 314.2524, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 50.15, "10th_percentile": 50.15, "90th_percentile": 50.15, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 28.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.38 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 24.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 40.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.53 } ] } ] }, { "description": "Hc Assay Of Estriol", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.19, "discounted_cash": 24, "minimum": 21.42, "maximum": 130.4596, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 28.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.85 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 36.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.47 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 31.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 52.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 39.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.9 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.86 } ] } ] }, { "description": "Hc Assay Of Estrogen", "code_information": [ { "code": "82672", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 627.39, "discounted_cash": 21, "minimum": 21.7, "maximum": 579.7084, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 382.71, "10th_percentile": 382.71, "90th_percentile": 382.71, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.13 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 32.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.22 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 28.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 46.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.78 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.78 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.02 } ] } ] }, { "description": "Hc Assay Of Estrone", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.09, "discounted_cash": 24, "minimum": 21, "maximum": 199.6672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 28.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 24.95, "10th_percentile": 24.95, "90th_percentile": 24.95, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 37.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.23 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 32.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 38.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 54.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.17 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.17 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.81 } ] } ] }, { "description": "Hc Assay Of Ethanol - 80320 - 30100052", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.61, "minimum": 1, "maximum": 122.5316, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 19.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 80.89, "10th_percentile": 80.89, "90th_percentile": 81.82, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 80.89, "10th_percentile": 80.89, "90th_percentile": 80.89, "count": "1 through 10" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.22 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Ethanol - G0480 - 30100052", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.61, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - 80320 - 30100071", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.61, "minimum": 1, "maximum": 122.5316, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 19.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 80.89, "10th_percentile": 80.89, "90th_percentile": 81.82, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 42.7, "median_amount": 80.89, "10th_percentile": 80.89, "90th_percentile": 80.89, "count": "1 through 10" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.22 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - G0480 - 30100071", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.61, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.81, "discounted_cash": 14, "minimum": 14.9, "maximum": 82.0604, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.78 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 32.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.58 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.58 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.09 } ] } ] }, { "description": "Hc Assay Of Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.01, "discounted_cash": 13, "minimum": 13.63, "maximum": 229.1612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 25.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 151.29, "10th_percentile": 36.39, "90th_percentile": 151.29, "count": "17" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.45 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 29.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.5 } ] } ] }, { "description": "Hc Assay Of Fetal Fibronectin", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520.58, "discounted_cash": 64, "minimum": 64.41, "maximum": 481.0159, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 100.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 154.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 103.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.7 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.07 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 83.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 65.7 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 139.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 106.25 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% 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": 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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.25 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.41 } ] } ] }, { "description": "Hc Assay Of Folic Acid, Rbc", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.31, "discounted_cash": 17, "minimum": 17.65, "maximum": 290.4224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 29.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.46 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 37.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.57 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.57 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.29 } ] } ] }, { "description": "Hc Assay Of Free Thyroxine", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.75, "discounted_cash": 9, "minimum": 9.02, "maximum": 153.153, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 62.98, "10th_percentile": 24.07, "90th_percentile": 62.98, "count": "76" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 13.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 19.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.88 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.88 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.12 } ] } ] }, { "description": "Hc Assay Of G6Pd Enzyme", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.03, "discounted_cash": 9, "minimum": 9.7, "maximum": 164.4997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 17.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 20.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.41 } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Iga, Igd, Igg, Igm, Each", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.12, "discounted_cash": 9, "minimum": 9.3, "maximum": 159.9629, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 24.84, "10th_percentile": 24.84, "90th_percentile": 74.51, "count": "11" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.49 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.49 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.34 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.34 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.76 } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.5, "discounted_cash": 16, "minimum": 13.99, "maximum": 216.678, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 17.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.27 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.71 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 21.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.27 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 35.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.34 } ] } ] }, { "description": "Hc Assay Of Gastrin", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 365.88, "discounted_cash": 17, "minimum": 17.63, "maximum": 338.0731, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 31.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 26.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.04 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.09 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.93 } ] } ] }, { "description": "Hc Assay Of Gentamicin", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.63, "discounted_cash": 16, "minimum": 16.38, "maximum": 287.0221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.71 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 35.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.04 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.34 } ] } ] }, { "description": "Hc Assay Of Ggt", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.48, "discounted_cash": 7, "minimum": 7.2, "maximum": 141.8155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 15.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.22 } ] } ] }, { "description": "Hc Assay Of Haptoglobin, Quant", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.38, "discounted_cash": 12, "minimum": 12.58, "maximum": 211.0231, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 33.56, "10th_percentile": 33.56, "90th_percentile": 33.56, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.83 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 16.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.83 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 27.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.75 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.75 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.9 } ] } ] }, { "description": "Hc Assay Of Hemosiderin, Qual", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.61, "discounted_cash": 4, "minimum": 2.3867, "maximum": 57.8516, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 2.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38 } ] } ] }, { "description": "Hc Assay Of Homocystine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.05, "discounted_cash": 17, "minimum": 17.92, "maximum": 328.9902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 26.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 45.01, "10th_percentile": 45.01, "90th_percentile": 45.01, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.28 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.88 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 36.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.83 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.83 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.64 } ] } ] }, { "description": "Hc Assay Of Imipramine - 80335 - 30100017", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.8, "minimum": 1, "maximum": 265.4652, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.42 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Imipramine - G0480 - 30100017", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.8, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Inorganic Phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.4, "discounted_cash": 4, "minimum": 4.74, "maximum": 106.6296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 71.2, "count": "11" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 10.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38 } ] } ] }, { "description": "Hc Assay Of Insulin", "code_information": [ { "code": "83527", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.24, "discounted_cash": 12, "minimum": 11.81, "maximum": 53.8138, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 16.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 27.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.36 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.36 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.55 } ] } ] }, { "description": "Hc Assay Of Insulin,Total", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.5, "discounted_cash": 11, "minimum": 11.43, "maximum": 191.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 11.43, "10th_percentile": 11.43, "90th_percentile": 30.51, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.66 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.78 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.66 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 24.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.85 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.85 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.31 } ] } ] }, { "description": "Hc Assay Of Iron", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 618.8, "discounted_cash": 6, "minimum": 5.5, "maximum": 571.7712, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 235.16, "10th_percentile": 17.27, "90th_percentile": 377.47, "count": "30" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 10.68 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": 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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.68 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.28 } ] } ] }, { "description": "Hc Assay Of Lactic Acid", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.65, "discounted_cash": 11, "minimum": 10.08, "maximum": 222.3606, "payers_information": [ { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 146.8, "10th_percentile": 28.51, "90th_percentile": 146.8, "count": "25" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.61 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 23.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.62 } ] } ] }, { "description": "Hc Assay Of Ldh Isoenzymes", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 682.65, "discounted_cash": 12, "minimum": 12.79, "maximum": 630.7686, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 23.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 27.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.12 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.12 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.55 } ] } ] }, { "description": "Hc Assay Of Lead", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.27, "discounted_cash": 12, "minimum": 11.7, "maximum": 190.5935, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 125.82, "10th_percentile": 125.82, "90th_percentile": 125.82, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.93 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.53 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.93 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 26.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.25 } ] } ] }, { "description": "Hc Assay Of Lidocaine", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 466.55, "discounted_cash": 14, "minimum": 14.69, "maximum": 431.0922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.98 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 22.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.23 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.23 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.45 } ] } ] }, { "description": "Hc Assay Of Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.17, "discounted_cash": 6, "minimum": 6.89, "maximum": 195.1211, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 18.38, "90th_percentile": 128.81, "count": "83" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.57 } ] } ] }, { "description": "Hc Assay Of Lipoprotein(A)", "code_information": [ { "code": "83695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.73, "discounted_cash": 14, "minimum": 14.32, "maximum": 217.8145, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 34.56, "10th_percentile": 34.56, "90th_percentile": 143.8, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.61 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.61 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 27.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.36 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.36 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.55 } ] } ] }, { "description": "Hc Assay Of Lithium", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.49, "discounted_cash": 6, "minimum": 6.61, "maximum": 166.7728, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 11.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.74 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.92 } ] } ] }, { "description": "Hc Assay Of Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.93, "discounted_cash": 6, "minimum": 6.7, "maximum": 144.0793, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 11.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 95.12, "10th_percentile": 17.87, "90th_percentile": 95.12, "count": "60" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.83 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.83 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.05 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.92 } ] } ] }, { "description": "Hc Assay Of Manganese", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.12, "discounted_cash": 26, "minimum": 13.4475, "maximum": 180.2909, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 39.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.06 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 34.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 52.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.65 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 40.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.65 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.56 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.51 } ] } ] }, { "description": "Hc Assay Of Mercury", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.94, "discounted_cash": 16, "minimum": 13.4475, "maximum": 233.7166, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 154.29, "10th_percentile": 154.29, "90th_percentile": 154.29, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.71 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 35.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.82 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.34 } ] } ] }, { "description": "Hc Assay Of Metanephrines", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 488.66, "discounted_cash": 16, "minimum": 16.94, "maximum": 451.5218, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.28 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.88 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 22.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 36.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.95 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.95 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.64 } ] } ] }, { "description": "Hc Assay Of Methadone - 80358 - 30100205", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.79, "minimum": 1, "maximum": 228.034, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.37 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.37 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.66 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Methadone - G0480 - 30100205", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.79, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Myoglobin", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.66, "discounted_cash": 12, "minimum": 12.92, "maximum": 247.3178, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.18 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 27.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.3 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.55 } ] } ] }, { "description": "Hc Assay Of Nickel", "code_information": [ { "code": "83885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.9, "discounted_cash": 24, "minimum": 8.01, "maximum": 259.5516, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 36.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.06 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 31.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 37.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 52.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.42 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.42 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.51 } ] } ] }, { "description": "Hc Assay Of Nortiptyline - 80335 - 30100013", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.84, "minimum": 1, "maximum": 265.4652, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.42 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 } ] } ] }, { "description": "Hc Assay Of Nortiptyline - G0480 - 30100013", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.84, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nos Vitamin", "code_information": [ { "code": "84591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 631.08, "discounted_cash": 17, "minimum": 14.5, "maximum": 583.1179, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 18.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.79 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.45 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.79 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 29.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.14 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.14 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.5 } ] } ] }, { "description": "Hc Assay Of Nucleotidase 5'", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 432.18, "discounted_cash": 11, "minimum": 11.15, "maximum": 399.3343, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.19 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 23.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.66 } ] } ] }, { "description": "Hc Assay Of Opiates - 80361 - 30100328", "code_information": [ { "code": "80361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.98, "minimum": 1, "maximum": 268.8655, "payers_information": [ { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.61 }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.98 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 13.34 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.61 }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.13 } ] } ] }, { "description": "Hc Assay Of Opiates - G0480 - 30100328", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.98, "discounted_cash": 114, "minimum": 6.999, "maximum": 650.0617, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 128.81, "10th_percentile": 128.81, "90th_percentile": 128.81, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% 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", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 421.14, "discounted_cash": 14, "minimum": 10.2781, "maximum": 389.1334, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.53 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 21.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.53 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 27.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.55 } ] } ] }, { "description": "Hc Assay Of Parathormone", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 758.78, "discounted_cash": 41, "minimum": 30.8215, "maximum": 701.1127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 30.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 110.16, "10th_percentile": 41.28, "90th_percentile": 110.16, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.79 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.93 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 53.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.79 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 63.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 89.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.09 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.09 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 92.14 } ] } ] }, { "description": "Hc Assay Of Phenobarbital", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.97, "discounted_cash": 15, "minimum": 15.3, "maximum": 243.9083, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.61 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.11 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 19.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.61 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 27.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.9 } ] } ] }, { "description": "Hc Assay Of Phenytoin, Free", "code_information": [ { "code": "80186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.79, "discounted_cash": 13, "minimum": 13.76, "maximum": 43.234, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 25.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.45 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 29.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.5 } ] } ] }, { "description": "Hc Assay Of Phenytoin, Total", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.97, "discounted_cash": 13, "minimum": 13.25, "maximum": 243.9083, "payers_information": [ { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 28.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 20.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.28 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Plasma Hemoglobin", "code_information": [ { "code": "83051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 540.23, "discounted_cash": 7, "minimum": 1.7451, "maximum": 499.1725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 1.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.33 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 10.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.33 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 15.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 12.06 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.06 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.22 } ] } ] }, { "description": "Hc Assay Of Porphobilinogen Urine Quan", "code_information": [ { "code": "84110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249.24, "discounted_cash": 8, "minimum": 7.88, "maximum": 230.2978, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 10.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 18.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.92 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.92 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.82 } ] } ] }, { "description": "Hc Assay Of Porphyrins Urine Quan&Fxj", "code_information": [ { "code": "84120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.54, "discounted_cash": 14, "minimum": 12.5, "maximum": 406.135, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 19.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "140.00% 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": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.45 } ] } ] }, { "description": "Hc Assay Of Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.19, "discounted_cash": 14, "minimum": 7.0061, "maximum": 245.0356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 7.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "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", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "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": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.45 } ] } ] }, { "description": "Hc Assay Of Pregnenolone", "code_information": [ { "code": "84140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.77, "discounted_cash": 20, "minimum": 20.67, "maximum": 140.2355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 35.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 92.58, "10th_percentile": 92.58, "90th_percentile": 92.58, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.08 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 31.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.46 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 26.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 44.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.1 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.07 } ] } ] }, { "description": "Hc Assay Of Primidone", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 411.3, "discounted_cash": 16, "minimum": 16.59, "maximum": 380.0412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 29.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.29 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 21.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 35.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.37 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.37 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.99 } ] } ] }, { "description": "Hc Assay Of Procalcitonin", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1527.36, "discounted_cash": 27, "minimum": 23.6, "maximum": 1411.2806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 31.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 931.69, "10th_percentile": 931.69, "90th_percentile": 931.69, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 40.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.73 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 42.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 57.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "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": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.18 }, { "payer_name": "Well Path Prison", "plan_name": "Well Path Prison", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.7 } ] } ] }, { "description": "Hc Assay Of Progesterone", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378.16, "discounted_cash": 20, "minimum": 20.86, "maximum": 349.4198, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicaid Adjusted Rate", "methodology": "fee schedule", "standard_charge_dollar": 38.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Freedom Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.7, "median_amount": 55.68, "10th_percentile": 20.86, "90th_percentile": 143.71, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Celtic Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "Celtic", "plan_name": "Celtic Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Celtic", "plan_name": "Home State Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Centurion", "plan_name": "Centurion", "methodology": "fee schedule", "standard_charge_dollar": 31.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthspring", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "plan_name": "COMP ALLIANCE - FKA COMPRESULTS Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.05 }, { "payer_name": "Corizon", "plan_name": "Corizon", "methodology": "fee schedule", "standard_charge_dollar": 27.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "plan_name": "HEALTH NET FEDERAL SERVICES - TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid (01/01/2025 to 12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Kansas Superior Select", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Midland Care Connection", "plan_name": "Midland Care Connection", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OHA Networks", "plan_name": "OHA NETWORKS WC", "methodology": "fee schedule", "standard_charge_dollar": 45.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.42 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC Ad-hoc", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.42 }, { "payer_name": "Well Path Prison",